Caring for the injured: Exploring the immediate and long-term consequences of injury in medieval Cambridge, England

Jenna M Dittmar* (Corresponding Author), Bram Mulder, Anna Tran, Piers D Mitchell, Peter Jones, Sarah A Inskip, Craig Cessford, John E. Robo

*Corresponding author for this work

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To combine paleopathological and biomechanical analysis to reconstruct the impact that a severe skeletal injury had on an individual’s ability to function and participate in medieval society.

Three medieval individuals from Cambridge, England with ante-mortem fractures to the lower limb were analyzed.

Plain X-rays were used to determine the degree of malunion, rotation and overlap of each fracture. Cortical bone architecture of the injured individuals and 28 uninjured controls were analyzed using micro-computed tomography (µCT). Clinical and functional consequences were examined using the Bioarcheology of Care framework.

The mechanism of injury, the secondary complications, and the extent of the care received was reconstructed for each individual. Bilateral asymmetry in the cortical bone architecture revealed the long-term alterations to each individual’s gait.

Each of these individuals survived a severe injury resulting in chronic physical impairment, though not all would have been considered ‘disabled’.

This research contributes to the discussion about medieval care provision and social constructions of disability by illustrating how an interdisciplinary approach provides insight into the experiences of those with physical impairments. The integration of µCT imaging within the Bioarcheology of Care model is a novel approach with great potential for application across the field.

Biomechanical analysis was restricted to cortical geometry.

Suggestions for future research
Further study of bilateral asymmetry in trabecular architecture could complement our understanding of altered loading modalities in past societies.
Original languageEnglish
Pages (from-to)7-19
Number of pages13
JournalInternational Journal of Paleopathology
Early online date16 Nov 2022
Publication statusPublished - 1 Mar 2023

Bibliographical note

Open Access through the Elsevier Agreement
The authors would like to thank Trish Biers of the Duckworth Collection at the University of Cambridge as well as the anonymous reviewers and editors of this special issue (Ileana Mircarelli, Lorna Tilley, and Mary Ann Tafuri) for their comments on this manuscript. This research was generously funded by the Wellcome Trust (Award no 2000368/Z/15/Z) and St John’s College, Cambridge.


  • Care
  • Skeletal trauma
  • Disability
  • Middle ages
  • Gait analysis
  • Micro-computed temography
  • Fracture


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