Life in 14th-century Cambridge, England, couldn’t have been easy. As the Black Death faded, it left behind a devastated society and many poor people. After years in which their bodies were worn by labor, disease, and hunger, the poorest often came to the doors of the Hospital of St John the Evangelist.

The Hospital of St John the Evangelist in medieval Cambridge was a small, quasi-monastic charity institution that selectively housed and cared for a few of the town’s poor, sick, or socially valued individuals. It wasn’t necessarily to heal them, but to offer spiritual and material refuge. It was the local social support system. But not everyone got in.

A new study looked at 400 human remains from the medieval hospital. The evidence suggests people from many different backgrounds
were selected, but several strict criteria were applied. St John the Evangelist was a gatekeeping institution, with the power to decide who was worthy of mercy—and who would be left outside.

The Rules of Charity

The hospital was founded around 1195, when Cambridge was little more than a trading town with muddy lanes and wooden buildings. The University of Cambridge hadn’t even been founded. The hospital was run like a tiny monastery, with clerics and lay staff living alongside the “inmates”—as residents were called. It had just enough space for a dozen or two. That meant in a city of thousands, where poverty was rampant and disease a constant shadow, the odds of getting in were small.

The hospital’s original charter laid out its mission: to care for the “poor and infirm,” especially poor scholars and “other sick people.” But some categories were explicitly excluded: pregnant women, lepers, the violently insane, and the gravely wounded. These were pragmatic decisions, though not exactly screaming “institutional mercy”.

Yet, when the Cambridge Archaeological Unit excavated the hospital’s graveyard between 2010 and 2011, they found a remarkably diverse mosaic of human stories.

From these 400 skeletons, researchers reconstructed an “osteobiography”—a kind of biography not of individuals per se, but of everything you can derive from bones. They studied age and sex as well as any signs of labor, malnutrition, disease. Isotopic signatures in teeth and ribs revealed lifelong changes in diet and location. DNA offered clues to gender, ancestry, and even family ties—or lack thereof.

From this, they pieced together a history of who got in.

A Diversity of Sorts

The hospital didn’t serve just one kind of person. Its population was more diverse than anyone expected—diverse not in ethnicity (most were genetically indistinguishable from other locals) but in circumstance. You could die there because you were a lifelong pauper. Or because you were a failed scholar. Or because you were simply too far from home when misfortune struck.

Some inmates were “structurally poor”—the medieval equivalent of generational poverty. These individuals had short stature, misshapen bones from rickets or infections, and signs of grueling physical labor. One woman stood barely five feet tall, but her upper arm bones were among the most developed in the entire cemetery. She had clearly lifted, hauled, and worked for decades—until she couldn’t. And then, finally, someone let her into the institution.

Others had fallen into poverty only late in life. These were the “shame-faced poor,” as medieval theologians called them—people who had once lived comfortably, but fell into need due to illness, widowhood, or bad luck. Remarkably, these individuals show high nitrogen isotope values in childhood (indicating a rich diet), which then drop significantly before death. They ate worse at the end of their lives than at the beginning. These were the people the hospital was more inclined to let in—victims of fate, not failure.

Then there were the young and sick. Tuberculosis shows up often in their bones—especially the spines. Many had cribra orbitalia, a sign of anemia. Some died before 25, their bodies stunted and scarred by childhood deprivation. These were not working poor. They were non-working poor—orphans, perhaps, or youth with chronic illness who had no family to care for them. For a medieval institution, these were the most pitiful cases. And pity was currency.

The Politics of Pity

This selectivity was not only logistical—it was theological. Charity in the Middle Ages was as much about saving the soul of the giver as helping the body. Donors gave alms and land to ensure that the hospital’s residents would pray for their eternal salvation. In return, the hospital managers curated a population of the pious and pitiful—not always the most desperate, but those who best fit a spiritual narrative of suffering.

“Like all medieval towns, Cambridge was a sea of need,” says Professor John Robb, from the University of Cambridge. “A few of the luckier poor people got bed and board in the hospital for life. Selection criteria would have been a mix of material want, local politics, and spiritual merit” says Professor John Robb from the University of Cambridge.

This also explains why the hospital would have preferred people who fell into bad luck, as opposed to those who were born with bad luck.

“Theological doctrines encouraged aid for the shame-faced poor, who threatened the moral order by showing that you could live virtuously and prosperously but still fall victim to twists of fortune,” stays Robb.

Archaeologists were surprised to also find bones of young men with symmetrical, gracile arms. Their bones showed none of the asymmetry or heavy development seen in laborers. Their bones looked… scholarly. And indeed, that fits.

The hospital had a mandate to care for “poor scholars”—students of the nearby university who, once old or ill, were no longer useful. These men often had good childhood nutrition and lived into middle age. They were not sickly. They were just out of place—too frail, too poor, or too inconvenient for the colleges that once housed them. The hospital became a kind of retirement plan for those who once had promise, but no longer had position.

Their presence is telling, but even among the educated, charity was conditional. This diversity of people who received help raises an intriguing and difficult question. How did the hospital make this selection?

The answer lies partly in the politics of medieval emotion. The hospital relied on donor money, and donors didn’t want their money to go just to the needy. They wanted their giving to reflect virtue—both theirs and the recipients’. That meant the hospital had to perform charity, in a way. Taking in the aged worker, the ailing orphan, the fallen scholar—these were characters in a moral play, one that gave meaning to wealth and death.

“They chose to help a range of people. This not only fulfilled their statutory mission but also provided cases to appeal to a range of donors and their emotions: pity aroused by poor and sick orphans, the spiritual benefit to benefactors of supporting pious scholars, reassurance that there was restorative help when prosperous, upstanding individuals, similar to the donor, suffered misfortune. As a long-term strategy, this served the communities of both Cambridge and the Hospital of St John the Evangelist well, maintaining the institution through several centuries of change in a way that a tightly focused, single-cause mission might not,” the researchers write in the study.

More Support Was Needed

Of course, for every skeleton in the hospital, there were dozens or hundreds who never made it through the door. The archaeologists note that Cambridge, like other towns, was likely filled with people living below the poverty line. The hospital was generous—room, board, and clothing for life—but to receive that gift, you had to be seen as the right kind of poor.

But what this study makes painfully clear is that there was not enough support for the less well-off. Medieval hospitals didn’t seem to operate on triage or egalitarianism. They operated on narratives—of virtue, fall, redemption, and pity.

And in that way, they’re not so far from us.

Today, people seeking help still navigate systems designed to assess worth as much as need. Welfare programs often have unexpected caveats and side effects. Homeless shelters ask for proof of sobriety. GoFundMe pages go viral not for the severity of the problem, but for how well it’s told. We have new technologies and better institutions, but sometimes, we end up asking the same questions in our society: Who deserves help, who doesn’t, and how do we decide?

The bones of a Cambridge graveyard can’t give us the answer. But their bones do speak. They tell us stories about the past and ask new questions. What will future archaeologists say about our times?

The study was published in the journal Antiquity.