Internet Archaeol. 5. Gernaey et el. Detecting Ancient Tuberculosis

The Test Site

Originally built between 1751-3, the Newcastle Infirmary at the Forth admitted patients from 1753 until 1906 when, as the Royal Victoria Infirmary, it moved to a new site at Leazes. The Infirmary burial ground, which received the unclaimed bodies of patients dying in the institution, was used between 1753 and 1845. After this date, interments took place in local parish churchyards, such as St Anne's, Newcastle. The Infirmary was enlarged in 1801-3 by the extension of the South Wing, and again between 1852-5 for the addition of the Dobson Wing. The Infirmary's work was both curative and instructive, and there is evidence of the latter in the surviving skeletal remains from the Infirmary burial ground (Boulter et al. 1998). The Infirmary was established for the "Sick and Lame Poor" of Durham and Northumberland, and patients had to be referred by one of the Infirmary's subscribers. Until 1803, those admitted were indeed almost exclusively "local", but after this date non-local patients were increasingly being treated, principally seamen from vessels docking in the Tyne and, in significant numbers after 1830, Irish immigrants. Occupations given in the Infirmary Burial Registers reflect the institution's role in providing a level of free health care to the working classes. In addition to sailors, the male patients included pitmen, labourers, soldiers and industrial workers. Female occupations are rarely given, though many were single women and may have been prostitutes, the treatment of whom formally became the Infirmary's responsibility after 1830. The Rules and Statutes of the Infirmary specifically prohibited the admission of children under 7 years (unless for an operation), the insane, sufferers from measles, infectious fevers, smallpox, incurable cancers, hectic fever, dropsy, palsy, highly developed scrofula and consumption (the latter two probably being synonyms for TB). The surviving Infirmary admissions registers show that as a rule these exclusions were maintained, however, diagnosis during this period depended upon observation alone. The causes of death given in the burial and discharge registers show that the accuracy of the initial diagnosis may be questionable, or that patients were admitted suffering apparently innocent disorders while incubating more serious diseases. Admissions records for 1778 to 1788 suggest that 10% of all patients admitted had tuberculosis, and surviving records suggest that 27.1% of patients died with tuberculosis (Nolan 1998).

The excavation of the former Newcastle Infirmary Burial Ground took place between November 1996 and March 1997, in advance of redevelopment of the site for the International Centre for Life. The redevelopment required that surviving human remains in the Burial Ground should be exhumed, and it was recognised by the Tyne and Wear Development Corporation that the burial ground offered a rare opportunity for osteological examination of a sample population group engaged in a variety of trades, and from the lower socio-economic order of a developing industrial society. With the notable exception of Spitalfields, few large-scale controlled and scientific archaeological excavations are known to have been conducted, or published, on post-medieval cemeteries and none apparently on 18th-19th century hospital burial grounds or in the north of England (Upson 1983; Mast 1987). Vault burials, which have been more recently investigated, tend to concern the middle and upper classes (Litten et al. 1998). Recent excavations, ascribed to the Edinburgh Royal Infirmary (Henderson et al. 1996), have produced a small group of human remains showing evidence of post-mortem autopsy or dissection comparable with that at Newcastle (Boulter et al. 1998).

The burial ground suffered significant disturbance during the last phase of the Newcastle Infirmary expansion in 1852-5 and, although no contemporary records of exhumation survive, the archaeological evidence clearly demonstrated that at least 407 individuals were disinterred and their remains disposed of, with little ceremony, in other parts of the burial ground. The apparent casualness with which these remains, many belonging to the only recently dead, were treated makes an interesting counterpoint to the popularly accepted view of mid-19th century reverence and concern for the dead. Interments in the Burial Ground were frequently layered, or stacked, within a grave space, and as the available space became crowded, there had been inter-cutting and reuse of graves. Beyond the use of rows and plots, no systematic or preferential use of space within the burial ground was discerned among the surviving burials; young and old, male and female being intermixed. Coffins, or the remains of coffins, were evident in almost half of these interments. The availability of this recently excavated, well-documented, skeletal collection provided an excellent opportunity to evaluate the possible use of mycolic acids as reliable biomarkers for the detection of ancient tuberculosis.