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FRIHUMSAM-Fri prosj.st. hum og sam

Medieval urban health: From individual to public responsibility AD 1000-1600

Alternative title: Middelalderbyens helse: fra individuelt til offentlig ansvar AD 1000-1600

Awarded: NOK 9.9 mill.

In light of recent international research, the project wanted to explore disease control and health development in Norwegian towns in the Middle Ages by examining whether the authorities had an active relationship to health and environmental conditions in the urban environment, and whether concrete measures were implemented to reduce disease incidence. With Trondheim in the period CE 1000-1600 as study object, the project wanted to investigate a) which infectious diseases appeared in urban environments in the Middle Ages? b) in what way, has frequence of infectious disease, climate, nutritional access and migration been instrumental in changing the view of disease as a private matter to become a public responsibility in the Middle Ages? Interdisciplinary working groups (WP) have collaborated on specific sub-issues. WP 1: Food access and the natural environment investigated how the natural environment and climate may have affected the urban residents' health situation. Some results: A study of a selected paleobotanical material from the city grounds and the high-status environment Erkebispegården in Trondheim showed that in addition to grain products, the diet was to a significant extent supplemented with berries and nuts. Imported walnuts have been included both in the archbishops palace environment and to some extent also in the diet of the urban population. Imports of grapes, pears, poppies, coriander, figs, cherries and walnuts were detected from the Archbishop's Farm. A review of skeletons from two medieval cemeteries showed damage to some of the skeletons as a result of malnutrition and (periodically?) small amounts of food. The diet of "ordinary" people in the city consisted i.a. of (impure) grain products and vegetables, but contributed to a certain extent to a deficiency of iron/vitamin B9/B12. Despite the fact that the diet has been varied, it seems that at times it has not been sufficient in quantity, probably a result of climate change with subsequent years and food shortages. Previous research has shown that a volcanic eruption in Indonesia in 1258 changed the climatic conditions globally, i.a. with severely impaired growth. The MedHeal600 project has been able to demonstrate the effects of this climate-historical event in the annual ring curves in samples of wood from houses and wooden bridges in Trondheim's streets and roads, which shows that at times there have been unfavorable climatic conditions for grain cultivation in Central Norway in the late 13th century, late 15th century and the decades around 1600. WP2: Water, waste and the spread of infection, asked questions about which contagious bacteria (phathogenes) occurred in the urban environment and how extensive the spread of the infection was. Some results: Samples of over 100 skeletons from 4 cemeteries in medieval Trondheim gave disappointingly only a handful of positive results: Only 3 individuals with leprosy infection were detected, 2 individuals have probably been detected with the plague bacterium Yersinia pestis, while 1 individual has been diagnosed with Salmonella. enterica, which produces a dangerous variant of Typhoid fever. Access and quality of water were investigated by e.g. to investigate groundwater quality, well depths, use of cisterns and well technology development. No direct physical, public measures to improve the water quality in the city could be demonstrated before a "public" water pipeline was built in 1777. Investigations of drainage of surface water have so far made it possible to adopt joint drainage measures in parts of the town. DNA and isotope analyzes have shown that the long-distance migration to Trondheim before the plague outbreak in 1349 and the subsequent outbreaks was significantly reduced after the outbreak. WP3: The establishment of a public health care system as a social practice: A new review of written source material was made to shed new light on population development, health and hygiene conditions. Some results: The hypothesis of a stagnation in population growth from the last half of the 13th century has been strengthened, but the previously assumed dramatic population decline in the 14th and 15th centuries of up to 70% must be significantly scaled down. The written source material testifies that central city authorities (king/city council) have actively contributed to regulating life in the city in a way that has promoted a better state of health. After the pandemic outbreak in 1349, an understanding grew that outbreaks of disease in the city could not be prevented based on the Church's explanation of disease and how disease could be combated. Based on a (renewed?) belief in the ancient miasm theory, infection-reducing measures were implemented during the 14th centur, in the public urban space that proved to reduce the spread of infection. This led to changes in attitudes towards hygiene as an infection-reducing measure. This change of attitude was taken further into recent times.

Betydning i et samfunns-/utviklingsperspektiv: Prosjektets forskning har produsert kunnskap om sosiale og kulturelle mekanismer for endring og implementering av tiltak for kvalitetsutvikling av miljø- og helseforhold som vil kunne være verdifull i planlegging og implementering av tilsvarende tiltak i store urbane agglomerasjoner med ukontrollerbar populasjonsvekst, og der andre religiøse, mentale og sosiale praksiser enn det som legges til grunn for utvikling av kollektive systemer for samfunnshelse vil være rådende.

MedHeal600´s hypothesis is that public health management derives from a number of specific practices to prevent diseases and debility caused by the particular physical environment that constituted the medieval urbanscape and the dependence of the ecological conditions that surrounded the towns. From this follows some fundamental questions: 1) If the present public health policy in Norway are founded on the development of practices and environmental conditions in medieval urban communities, in which way influenced the ecology surrounding the towns the population´s health condition? 2) How did the frequency of infectious diseases vary in time and how did it relate to the urban environment? 3) If the public health evolved from individual health practices to the actions for public health, what factors caused this grund-breaking development? The overarching methodological principle is to compare the ecological surroundings and physical health-interventions visible in the built environment in medieval Trondheim with the development of health -, diet- and mobility. The basic information will be gathered from the collection of human bones/skeletons from medieval cemeteries in Trondheim. Biomolecular analysis is applied to identify the character and volume of infectious deceases in the urban population during the periode c. AD100-1600. To identify mobility genetic and infectious deceases DNA analysis is applied. To identify mobility and diet, isotope analysis is applied. The research is based on a interdiciplinary cooperation between a diverse set of scolarly competence and a multiple set of data, sources and methods. Knowledge of how health developed over time and in physical environments differ from present time will enhance the understanding of processes relevant for planning and implementing public health management in present low-resource urbanized areas.

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FRIHUMSAM-Fri prosj.st. hum og sam