Comparison of natural and non-natural deaths in medieval (1452–1485) and contemporary Milan

Background Long-­ term historical trajectory of violence remains insufficiently understood. Methods This study examines long-­ term changes in natural/non-­ natural mortality by comparing cause-­ of-death data from late medieval and contemporary Milan. It aims to reconstruct medieval patterns and assess changes in age-­ specific and sex-­ specific distributions of violent and accidental deaths. Causes of death recorded in the Liber Mortuorum (LM), a civil death register in use in Milan since at least 1451, were compared with 21st-­ century mortality data from the Milan province. Causes of death in the LM were translated from Latin and classified as natural or non-­ natural (accidents, homicides or suicides). Comparisons were made using the age-­ adjusted proportional mortality ratio (PMR) and the female-­ to-­ male ratio. Results The LM recorded 16 288 deaths over 8 non-consecutive years between 1452 and 1485, 15 861 with age at death available. These included 217 deaths from non-­ natural causes: 118 accidents, 68 homicides, 7 suicides and 24 deaths of undetermined intent. Accidental deaths accounted for 61.1% of non-­ natural deaths with determined intent in the LM compared with 79.9% in contemporary data. Among non-­ natural causes, deaths from homicides were more frequent in the medieval period than in contemporary times (35.2% vs 1.5%, age-­ adjusted PMR: 7.6). In the medieval period, 5.9% of homicide victims were female compared with 31.5% in recent data, with the female-­ to-­ male mortality ratio increasing from 0.06 to 0.46. Suicides were rarely reported in the LM. Conclusions Homicide was more frequent in general in medieval times, even though female homicide appears proportionally more represented in contemporary data than in the 15th-­ century records and represents a key finding of the study.