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. Author manuscript; available in PMC: 2025 Sep 5.
Published in final edited form as: Am J Biol Anthropol. 2024 Sep 5;185(3):e25009. doi: 10.1002/ajpa.25009

Dying of pestilence: Stature and mortality from the Black Death in 14th-century Kyrgyzstan

Умирая от чумы: рост и смертность от Чёрной Смерти в Кыргызстане в XIV веке

David W Hansen 1,2, Sharon N DeWitte 1,2,*, Philip Slavin 3
PMCID: PMC11495995  NIHMSID: NIHMS2017610  PMID: 39238322

Abstract

Objectives:

Bioarchaeological studies have provided important information about mortality patterns during the Second Pandemic of Plague, including the Black Death, but most to date have focused on European contexts. This study represents a spatial contribution to plague bioarchaeology, focusing on Central Asia, the origin of the Second Pandemic. We examine the relationship between stature and plague mortality during an outbreak of plague at Kara-Djigach in northern Kyrgyzstan in 1338-39, the earliest archaeological site known to contain victims of the Black Death in Eurasia.

Methods:

This study uses epigraphic data and in situ measurements from the Syriac Christian cemeteries at Kara-Djigach, obtained from field notes from excavations conducted by Russian archaeologists in the 1880s (n=34 individuals). The epigraphic data provide detailed information about the interred individuals, including occupations, year of death, and gender. In situ measurements provide data on adult stature. This study uses Chi-square and Fischer’s exact tests to examine relationships between stature and plague at the site.

Results:

We find evidence that relatively short people were disproportionately affected by plague when compared to non-plague years.

Discussion:

These results might reflect increased mortality risks from plague based on exposure to early life biological stress events.

Keywords: medieval plague, developmental origins of health and disease, frailty

1. Introduction

The Black Death was a pan-continental pandemic that spread across Eurasia and North Africa in the 14th century and represented the first wave of the Second Plague Pandemic, which lasted until the early 19th century in some contexts (Varlık, 2017). Yersinia pestis has been confirmed as the cause of the Black Death via ancient DNA analyses of human skeletons excavated from several archaeological sites (Bos et al., 2011; Spyrou et al., 2016), and ongoing research has honed its geographic origins to the mountainous regions of Central Asia, most likely the Tian Shan range (Green 2014, 2020; Slavin 2019, 2023a, 2023b, 2023c; Spyrou et al., 2022).

Recent research has diverged from a traditional Eurocentric perspective of the Black Death, and there is a growing awareness of the quasi-global nature of the pandemic (Green, 2014, 2018, 2020; Fancy and Green, 2021; Borsch and Sabraa, 2017; Slavin 2019, 2023a, 2023b, 2023c; Barker, 2021; Spyrou et al., 2022). Some of these studies combine genetic research, archaeological data, and historical sources to create an account of the possible mechanisms and pattern of spread of the Black Death across Eurasia and North Africa. Nonetheless, most Black Death-related studies remain Eurocentric.

Bioarchaeological studies have provided important information about mortality patterns during the Second Plague Pandemic. Previous paleoepidemiological research on the Black Death in England has revealed evidence that risks of mortality varied with respect to age and previous exposure to physiological stressors. For example, several studies have produced evidence that individuals with skeletal evidence of early childhood stressors faced higher hazards of death during the Black Death compared to their peers (DeWitte and Wood, 2008; Franklin et al, 2023; Godde et al., 2020). DeWitte and Slavin (2013) suggest that the Great Bovine Pestilence of 1319-20 in England and Wales and subsequent shortage of dairy products may have had an impact on human health and rendered individuals who had experienced this shortage more highly susceptible to infectious diseases, including plague, during adulthood. With respect to the current study, DeWitte and Hughes-Morey (2012) found that estimated risks of mortality during the Black Death in London were higher for adults of short stature compared to those of normal or tall stature, though this study did not find a correlation between the Great Famine of 1315-1317 and short stature as suggested by the findings of Godde et al (2020), perhaps as a result of different variables included in the analyses of the respective studies.

Outside of the British Isles, bioarchaeological research on the 14th century Black Death has taken place across Western Europe. Kacki et al. (2011) conducted an immunological study of the Black Death using samples from people interred in a cemetery in southern France. They found that only during extreme mortality events did communities dramatically alter their funerary practices and use mass burials; otherwise plague victims were buried using traditional individual inhumations. Kacki and Castex (2014) found overrepresentation of 5–19-year-olds in a 14th century plague cemetery in Barcelona, Spain. More recently, Castex and Kacki (2016) have examined the demographic patterning that is found in plague cemeteries across Europe, demonstrating that plague mortality did not vary by sex. Studies from later outbreaks during the Second Pandemic focus on cemeteries in Italy, Germany, Belgium, and Denmark, in addition to England, France, and Spain (Bramanti et al., 2018).

Our study represents a temporal and spatial expansion of plague bioarchaeology, focusing on 14th-century Central Asia and specifically the fortified settlement of Kara-Djigach in the Chüy Valley of northern Kyrgyzstan in 1338-39, the earliest archaeological site known to contain victims of the Black Death in Eurasia. Historians mentioned the cemeteries of Kara-Djigach and Burana (a nearby contemporary archaeological site) as likely plague locations within just a few years of their excavation (Chwolson, 1890). Recent work by Slavin (2019, 2023a) and Spyrou et al. (2022) have shown a massive increase in the number of deaths during the years 1338-9 using epigraphic records from the cemeteries. Of the 467 dated gravestones from 1248 to 1345 across the two cemeteries, 118 (25%) date to the years 1338-1339 – with ten additionally stating that the individual “died of pestilence” (mawtānā in Syriac). Slavin points to similar mortality ratios at Black Death cemeteries in Europe as suggestive that the pestilence present in 1338-1339 was an outbreak caused by Yersinia pestis. This hypothesis was recently confirmed by aDNA evidence from three individuals from the 1338-9 burials at Kara-Djigach (two of whom are included in the current study), which established the presence of a strain of Y. pestis that is positioned ancestral to the strain that caused the European Black Death (Spyrou et al., 2022). Recently, Slavin (2023a), based on the dated tombstones from Kara-Djigach and Burana, has shown an over-representation of younger women in the epigraphic record during the 1338-9 outbreak, in contrast with other crisis years in the period 1248-1345 when adult men are more heavily represented.

Our study builds on this research on the Black Death, and specifically addresses the question of whether there was variation in mortality patterns based on previous exposure to physiological stress during the Black Death in Central Asia. We use data from archaeological field diaries from the excavation of the cemetery at Kara-Djigach to examine whether there is a relationship, in general, between adult stature and plague mortality at this site.

1.1. Archaeological and Historical Background

This study focuses on the fortified settlement of Kara-Djigach, situated in the Chüy Valley of northern Kyrgyzstan along the Ala-Too range of the northern Tian-Shan mountains. This settlement was located along the northern branch of the transcontinental trade routes often referred to as the Silk Road. The cemetery was excavated in three seasons: in 1885, 1886 and 1892 by Nikolay Pantusov and Aleksey Fetisov.

Situated just to the south-east of present-day Bishkek, Kara-Djigach appears to have been first settled by Christian immigrants from other parts of Central Asia in the 1240s, with the earliest tombstone dated to 1248. The remains of this settlement are currently located in an agricultural zone, and the necropolis that the original excavations uncovered is now active farmland (Kamishev, 2012; Dickens, 2009).

The individuals interred at the cemetery at Kara-Djigach belonged to the Church of the East (East Syriac or Nestorians), which originated in early-5th century Syria, quickly spread into Mesopotamia, Persia, and Central Asia, reaching Tang China in the earlier 7th century. In Central Asia, the Church of the East was active, with periods of intermittent decline until the late 14th century (Klein, 2000; Dickens, 2015, 2021; Kolchenko, 2019). There is a large body of archaeological and archival data supporting the existence of the Church of the East in Central Asia, particularly in the Chüy Valley of Kyrgyzstan. In addition to some 630 Christian gravestones (kayraks) found at Kara-Djigach and Burana, several church ruins have been found across the region, such as in the town of Ak-Beshim (Suyab), located halfway between Burana and Kara-Djigach. Ceramic, bronze, and stone artifacts with crosses and other Christian symbols have been found in excavations of cities in the Chüy Valley and other parts of the Zhetysu (Semireych’ye) region in southern Kazakhstan, as well as western Uyghuristan/Xinjiang, Inner Mongolia, Samarkand and Urgut in Uzbekistan, and Merv, Turkmenistan, among others (Zhukova, 1994; Comneno, 1997; Klein, 2000, 2002, 2004; Kamishev, 2012; Dickens, 2009, 2015, 2017, 2021; Halbertsma 2015; Kolchenko 2018).

Tombstone inscriptions from Kara-Djigach and the nearby cemetery of Burana, about 630 in total, mostly in Syriac but some in Turkic or Syro-Turkic, have been assembled, edited, translated and analyzed by several philologists and historians (Chwolson, 1890, 1897; Slutskii, 1889; Klein, 2000; Dzhumagulov, 1968, 1971, 1982, 1987, 2011; Hjelt, 1909; Nau, 1913; Dickens, 2009, 2016; Fedotova et al., 2020; Dickens and Avtushkova, 2021; Borbone, 2021; Borbone and Smelova, 2022). These gravestones generally provide demographic data including the interred individuals’ names, year of death, gender, a rough indication of an age group (‘boy/girl’, ‘young man/woman’, ‘faithful man/woman’ and ‘old man/woman’), and occasionally, information on occupation and familial relationships to other members of the community. The length of inscriptions and fineness of decoration varies from case to case, from just a few words with a crude cross to a 13 lines-long epitaph with an exceptionally sophisticated cross decoration. Some tombstones, especially in Burana, have no inscriptions at all. This undoubtedly reflects the variation in socio-economic status across interred individuals (Slavin, 2023a). The same pattern can be observed at another Christian site at Ucharal, identified with Ilibalyk, in South-eastern Kazakhstan close to the border with China (Stewart and Gilbert, 2022).

1.2. Stature as an indicator of frailty

Adult stature is determined largely by genetics, but it can also reflect environmental conditions such as maternal health, and childhood nutritional status and infectious disease experiences (Perkins et al., 2016; Bourke et al., 2016; Silventoinen, 2003; Steckel, 1995). These early life conditions not only have the potential to affect achieved adult stature but can also produce long-term consequences across the life course, as articulated by the Developmental Origins of Health and Disease hypothesis (Barker and Osmond, 1986; Barker et al., 1993; Gowland and Caldwell, 2022). Individuals who face biological stressors, such as episodes of infectious disease and malnutrition, in utero or during early childhood can experience stunted growth and delayed development across multiple tissues and organ systems as the body redirects energetic and nutrient resources towards maintenance of essential functions and immune responses and away from growth and development (Steckel, 1995). This, in turn, can have long-term impacts on individual health and has been found to be correlated with health outcomes from a variety of diseases as well as risks of mortality later in life when controlling for behavioral factors and socioeconomic status (Bourke et al., 2016; Gage and Zansky, 1995; Grasgruber and Hrazdíra, 2020; Onis et al., 2008; Song et al., 2003). For example, stature was found to be inversely correlated with cardiorespiratory disease- and cancer-related mortality in a longitudinal study in Scotland in the 1970s, even after controlling for socioeconomic status at time of death (Smith et al., 2000). A 2012 meta-analysis of over one million adult participants found a negative association between height and a range of chronic health conditions, including heart and liver disease, certain types of stroke, and some cancers (Emerging Risk Factors Collaboration, 2012). A retrospective cohort study in China found that individuals exposed in utero and in infancy to the mid-20th century Chinese Great Famine had increased risk of short stature and hypertension in adulthood when compared to individuals born after the famine, after controlling for socioeconomic differences (Wang et al., 2012).

The associated developmental stress that can cause short stature can also negatively impact the development of the immune system, producing permanently compromised immune function and thus heightened susceptible to a variety of infectious diseases throughout life (Bourke et al, 2016; McDade, 2005). Several studies among living people have found associations between malnutrition and immune suppression (McDade, 2005; Moore et al., 1999; Moore, 2017; Palmer, 2011; Scrimshaw, 2003; Spencer, 2014). Malnutrition in utero and during early childhood specifically are associated with increased risks of mortality from infectious disease in adulthood (Moore, et al., 1999; Moore, 2017)). It is also possible that rather than compromised immune responses being the result of malnutrition during development, individuals with inherently compromised immune systems might have been more vulnerable to infectious disease during childhood and thus stunted because of energetic resource allocation away from growth (McDade, 2005; McDade et al., 2008). Further, there is evidence that chronic diseases associated with short stature are also risk factors for infectious disease (Badawi et al., 2019).

Stature has been found to be inversely associated with risk of mortality (higher risks of mortality for people of relatively short stature) and positively associated with survivorship (longer lifespans for people of relatively tall stature) in bioarchaeological studies (Roberts and Manchester, 2009). For example, Kemkes-Grottenthaler (2005) found that taller individuals had a survival advantage compared to shorter individuals using skeletal data pooled from individuals across Europe from 500-1900 CE. DeWitte and Hughes-Morey (2012) found that individuals with below-average stature experienced increased mortality risk during the Black Death in London, and DeWitte and Yaussy (2017) found increased mortality risk for short individuals during famine conditions in medieval London. Similarly, DeWitte and Slavin (2013) suggest that individuals who had experienced dairy deficiencies during infancy and early childhood development were at a higher risk of death during the Black Death in London. Van Tiel and McFadden (2021) found an increase in mortality risk for females of low stature during childbirth in Neolithic to Iron Age Southeast Asia. Individuals living in medieval York who died between the ages of 17-25 were shorter on average than those who lived to be older than 25, suggesting a relationship between mortality risk and short stature in the population (Watts, 2011).

2. Skeletal Data and Methods

The data for this study come from n = 34 individuals from the Kara-Djigach excavations, conducted by Nikolay Pantusov and Aleksey Fetisov in 1885 and 1886 (Table 1). The data from these field seasons, including skeletal condition, measurements, and burial objects, were recorded and sent to the Imperial Archaeological Commission (which no longer exists) in St Petersburg. In the course of the excavations of the sites, no full skeletons were removed from their graves. Thus, the information regarding the stature of individual skeletons, used in our study, derives from Pantusov’s field diary (currently held at The Archive of the Institute of Material Culture History of the Russian Academy of Sciences, St. Petersburg, Fund 1, Inventory 1, File 40b), and not from analyses we have performed ourselves on the actual human skeletal remains. The individuals included in our study do not have known living relatives; Spyrou and colleagues (2022, see Supplementary Information) found that the genetic diversity of several of the individuals (for whom genomic analyses were possible) from Kara-Djigach and the nearby site of Burana fell within the diversity of central Eurasian populations, but did not overlap that of any present-day populations living in Kyrgyzstan. Further, there are no local communities at the site of the cemeteries: during the Soviet-era collectivization in the 1930s, the cemeteries were converted into “open fields” of new kolkhozes, which were dissolved with the fall of the USSR in 1991. Given that we used recorded data on stature and did not examine the human skeletal remains ourselves, no formal approval for this study was required. Of the total 467 dated inscriptions from the period 1248-1345, 118 are from 1338-9, with ten inscriptions indicating “pestilence” as the cause of death for eleven individuals. aDNA analysis of three individuals from 1338-9 burials at Kara-Djigach by Spyrou et al. (2022) established the presence of Y. pestis, thus confirming that the “pestilence” was plague. Therefore, all burials from 1338-9 are classified here as plague burials.

Table 1:

Data used for analysis from Kara Djigach Cemetery

Grave # Gender Skeletal height Plague year
1 M 142.24 YES
4 M 168.91 NO
7 M 155.575 YES
11 M 163.35375 NO
13 M 144.4625 YES
20 M 146.685 YES
21 M 144.4625 YES
23 M 171.1325 YES
30 M 162.2425 YES
32 M 144.4625 YES
39 M 157.7975 NO
41 M 160.02 NO
50 M 166.6875 UNKNOWN
52 M 166.6875 NO
59 M 166.6875 NO
66 M 173.355 NO
67 M 157.7975 NO
75 M 156.68625 YES
3 W 155.575 NO
6 W 146.685 UNKNOWN
8 W 128.905 NO
9 W 144.4625 YES
19 W 146.685 YES
33 W 153.3525 YES
37 W 144.4625 YES
40 W 158.90875 NO
48 W 148.9075 NO
51 W 151.13 NO
57 W 151.13 NO
63 W 151.13 NO
68 W 145.57375 NO
69 W 151.13 NO
74 W 174.46625 NO
77 W 150.01875 NO
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Due to the incomplete data from the archaeological reports and epigraphic data, only the 34 individuals from Kara-Djigach for whom both stature and gender data were available were used in this study. In situ measurements of skeletal length from adult burials in Kara-Djigach by Pantusov and Fetisov were used as a proxy for stature.

2.1. Gender and age-at-death

The 34 individuals included in this study were associated with kayraks (headstones). As noted above, the headstones from this site in general provide demographic information, including name, year of death, gender, and approximate age group designated as ṭalyā/ṭlītā (boy/girl normally indicating the age of under twelve),ʿlaymā/ʿlaymtā (young man/woman, normally indicating the age range of twelve to 20), mhaymnā/mhaymantā (faithful man/woman, individuals over 20 years of age), and sabā/sabtā (old man/old woman) (Spyrou et al., 2022; Slavin, 2023a).

The identities of these individuals are known from their associated headstones, which were written in Syriac. In the Syriac language, like other Semitic languages, grammatical gender is used to match descriptors to the referent in a way that reflects the gender of the individual. On the gravestones, this is often found in relationship to the title of the decedent, with females described with the suffix “tā” affixed to the title being used (ṭlītā/ʿlaymtā/mhaymantā/sabtā). In addition, personal names, whether Biblical-Classical or Turkic, provide another confirmation of their bearers’ gender. Finally, some inscriptions describe the deceased with statements like “daughter of…” or “son of…”, which further provide evidence of the individual’s gender.

Given that in human populations, average stature typically differs between men and women, we use the gender data from headstones to determine gender-specific mean statures for identification of individuals of short stature. This approach ensures that any potential difference in frequencies of short adults between the plague and non-plague burials are more clearly reflective of mortality with respect to previous exposure to stressors rather than an artifact of differing proportions of men and women between the burial types. We emphasize that we are using culturally specific epigraphic information about gender and are not imposing present-day normative perspectives regarding gender that have been criticized (see for example, Agarwal (2012) and DuBois and Shattuck-Heidorn (2021)). We note that our sample size is rather small, and thus we have not included analysis of the potential variation by sex in the relationship between stature and plague death.

Age at death was determined using epigraphic information. Exact age at death was not recorded; rather, linguistic information provided broad age descriptors that fall into three age categories, children under 12 years (ṭalyā/ṭlītā), young individuals aged 12-20 (ʿlaymā/ʿlaymtā), adults aged 20 and older (mhaymnā/mhaymantā), and older adult (sabā/sabtā). Given that we are interested in variation in mortality by achieved adult stature, for our study, individuals from the groups under 20 years of age (i.e., children under 12 years and young individuals aged 12-20), were excluded to prevent the possible inclusion of individuals still in the process of skeletal development, despite some of them having potentially reached social adulthood.

2.2. Stature estimation

Measurements were taken of burials in situ for both coffin length and skeletal length by Pantusov and Fetisov. During the excavations, the entire skeletons were measured inside their coffins, before the former were examined and before anything was removed from the coffins. Our analyses were done using the metric conversion of these data from Russian imperial units. Using these measurements as a proxy for stature, we then calculated mean stature by gender for adults (n = 34 with known stature and gender) to examine patterns of vulnerability to plague mortality resulting from developmental stress. For men, in situ mean stature was 158.29 centimeters. For women, in situ mean stature was 150.16 cm. For this study, we used two different criteria for evaluating relative stature (i.e., whether an individual was short or of average/tall stature). In the first approach, stature was considered short if an individual’s in situ measurement fell below their gender-specific population-level mean stature and average/tall if it was equal to or greater than the gender-specific mean stature. However, we recognize that this criterion may not be sufficiently stringent, given potential errors in measurement or other factors. Thus, we also used a second approach, in which stature was considered short if an individual’s in situ measurement fell below their gender-specific population-level mean stature minus one standard deviation and average/tall if it was equal to or greater than the gender-specific mean stature minus one standard deviation. We note that given small sample sizes, and our interest in relatively short stature specifically as an indicator of frailty, we pool average and tall statures in our analyses.

2.3. Statistical analysis

For the dataset using the first criterion for evaluating stature (i.e., below the mean vs. at/above the mean), Chi-square tests were used to assess the associations between stature (using dichotomous data: 0 = short, 1 = average/tall) and plague (0 = death during non-plague year, 1 = death during plague year). Using the criterion of “mean minus one standard deviation” yielded only a single individual among the non-plague year burials that we scored as “short”. Thus, for the dataset using this approach to evaluating stature, we applied the Fisher’s exact test. In both cases, we use tests of independence, and thus significant results allow us to reject the null hypothesis that there is no association between stature and plague. N=34 individuals were used for the calculation of mean stature, with n=32 included in the analyses related to plague mortality given the lack of information on year of death for two individuals in the larger sample. Statistical analyses were done using SPSS version 28. Due to the small sample sizes available for this study, associations were considered significant at alpha = 0.1, following other bioarchaeological studies with similar samples sizes (DeWitte and Lewis, 2020; DeWitte, 2018). Associations at this alpha level can reflect trends that may otherwise be ignored by adherence to a more conservative alpha level.

3. Results

3.1. Adult Stature and Plague Mortality

Using data from all adults (i.e., pooled genders), comparison of the frequencies of average/tall (pooled) individuals and short individuals among those who died during plague vs. non-plague years reveals a significantly higher frequency of short adults in the plague burials, regardless of our criterion for determining short stature (below the mean, p=0.012, Table 2; below the mean minus one standard deviation, p = 0.029, Table 3). The distance of each individual’s stature measurement from the relevant gender-specific mean, for the plague and non-plague burials separately, is shown in Figure 1.

Table 2:

Observed vs. expected counts and frequencies of short (less than the gender-specific mean) and average/tall (at or greater than the gender-specific mean) individuals within each burial type.

Short (below the mean) Average/Tall (at or above the mean) χ2 value p-value
Plague Observed 10 (62.5%) 6 (37.5%) 6.348 0.012
Expected 6.5 (40.6%) 9.5 (59.4%)
Non-Plague Observed 3 (18.8%) 13 (81.3%)
Expected 6.5 (40.6%) 9.5 (59.4%)
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Table 3:

Observed vs. expected counts and frequencies of short (less than the gender-specific mean minus one standard deviation) and average/tall (at or greater than the gender-specific mean minus one standard deviation) individuals within each burial type.

Short (below the mean) Average/Tall (at or above the mean) χ2 value p-value
Plague Observed 5 (38.5%) 8 (61.5%) 5.584 0.029
Expected 2.4 (18.5%) 10.6 (81.5%)
Non-Plague Observed 1 (5.3%) 18 (94.7%)
Expected 3.6 (19%) 15.4 (81%)
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Figure 1:

Figure 1:

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Distance of each individual’s measurement from the relevant gender-specific mean (observed measurement minus the mean), separated by burial type.

4. Discussion

The results of this study suggest that in general, at the emergence of the Black Death in the Tian Shan region of the Chaghadaid khanate in the late 1330s, relatively short people, and by inference those who might have experienced early life stress severe enough to compromise growth, were at heightened vulnerability to plague mortality in adulthood compared to people of average or tall stature. As noted in the Methods section, given small overall sample sizes available for this study, we have pooled average and tall individuals and thus have not discerned whether there was any advantage for those of relatively tall stature in this context. Overall, our findings are consistent with the results of DeWitte and Hughes-Morey’s (2012) study that suggests an association between short stature and increased mortality risk from the Black Death in medieval London.

Our findings might reflect the long-term consequences of exposure to stressors early in development, as detailed above. That is, people who were of relatively short stature in our sample might have experienced stressors, such as malnutrition associated with environmental and food crises, during critical developmental windows that restricted growth and development and thus produced both short adult stature and permanently compromised immune function. This, in turn, might have elevated their risks of death from infectious diseases in adulthood, and specifically during the Black Death, compared to their peers who were of average or tall stature and thus presumably had not been exposed to stressors in childhood sufficient to compromise growth and immune function. Alternatively, the relatively short individuals in our sample might have been born with inherently compromised immune systems, which would have made them more likely to suffer from infectious diseases early in life, which in turn would have resulted in growth restriction, and during adulthood when exposed to plague. The innate compromised immune systems may have been a product of an intergenerational effect of food and nutrient deficiency on two subsequent generations (Cheng et al., 2020; Zamenhof et al., 1971).

Our finding of an association between short stature and plague death, in general, may reflect heterogeneous frailty in the population that resulted from variation in exposure to stressors prior to the emergence of the Black Death in the Tian Shan region. For example, there were at least 12 episodes of excess mortality at Kara-Djigach between 1264 and 1337, which may have been associated with subsistence crises caused by climatic shocks and violence (Slavin, 2023a). It is possible that the shorter victims of the plague outbreak of 1338-9 survived some of these crises as children and adolescents, but the experience of episodes of malnourishment during critical developmental windows rendered them relatively frail as adults. This general mechanism was previously suggested with respect to the Black Death in London, i.e., those who likely experienced long-term dairy deficiency resulting from the Great Bovine Pestilence of 1319-20 as children or adolescents, tended to be frailer adults exhibiting numerous skeletal stress indicators and more vulnerable to Black Death mortality (DeWitte and Slavin, 2013).

One possible factor driving variation in frailty is differential socioeconomic status, which can, for example, affect exposures to infectious diseases, access to health promoting resources (such as sufficient and nutritious food), and experiences of psychosocial stressors that can have long-term health consequences. The individuals in this sample from Kara-Djigach are relatively high-status individuals, given that that they all have associated grave inscriptions. As these gravestones were inscribed in a liturgical language not spoken by the population at large, specialists would have been hired to inscribe such detailed texts on the headstones, something the poorest in the population would likely have been unable to afford (Slavin, 2023a). The individuals in this sample are those with epigraphic text detailed enough to provide gender and year of death, which we infer to be evidence of having the resources to pay for a carved gravestone with inscriptions long enough to provide these data. There is variation in inscription length among these individuals, which may or may not reflect wealth inequality, but it is beyond the scope of the current study to examine the possible association between wealth variation among the individuals in our sample and susceptibility to plague.

In summary, our findings suggest that short stature, reflective of developmental stress and perhaps ongoing stressors across the life course, rendered people more vulnerable to mortality during the Black Death in 14th-century Kyrgyzstan. This is consistent with bioarchaeological findings from European contexts indicating that exposure to stressors prior to the Black Death affected risks of death during the pandemic itself. Whether this association, which suggests heightened risk of plague mortality for people of short stature, was consistent across genders in this context remains to be seen. Our findings hint at the possibility of gender differences in the association between short stature and plague mortality, and thus perhaps gender differences in the effect of developmental stress on later outcomes with respect to this particular disease, but further work with larger samples sizes is necessary to determine if this effect is genuine.

Acknowledgements:

We are grateful to the Editor-in-Chief, the Associate Editor, Editorial Board Member, and two anonymous reviewers for their careful reading of the original manuscript and their helpful and encouraging comments. We also thank Dr. Carlina de la Cova and Dr. Magdalena Stawkowski for proving feedback on the project that gave rise to this paper. This research was funded by a National Science Foundation Graduate Research Fellowship (DGE – 2034711). This research benefited from administrative and computing support through the University of Colorado Population Center (CUPC) funded by Eunice Kennedy Shriver National Institute of Child Health & Human Development of the National Institutes of Health (P2CHD066613). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH, CUPC, or the University of Colorado.

Data Availability Statement:

All data reported on here and used in this analysis are provided in Table 1.

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Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Data Availability Statement

All data reported on here and used in this analysis are provided in Table 1.

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