"A custome lothsome": Investigating the association between tobacco consumption and respiratory inflammation in two post-medieval English populations (c. CE 1500-1855).

Despite current clinical knowledge of the risks associated with tobacco consumption, the bioarchaeological investigation of tobacco's effect on health in past populations remains woefully underexamined. This study explores the potential respiratory health implications of the rapid incorporation of tobacco-use into the everyday lives of English citizens during the post-medieval period. Adult skeletons from urban post-medieval St James's Gardens Burial Ground, Euston, London (N = 281; CE1789-1853) and rural post-medieval (N = 151; CE1500-1855) and medieval (N = 62; CE1150-1500) Barton-upon-Humber were examined. Individuals were assessed for tobacco consumption status using osteoarchaeological and biomolecular methods. Individuals were observed for bone changes related to inflammation within the maxillary sinuses and within the pleural/pulmonary regions. Statistical tests revealed a significant association between tobacco consumption and the presence of pulmonary/pleural inflammation in the Barton-upon-Humber post-medieval group. Tobacco consumers at Barton-upon-Humber were also more than twice as likely to present with maxillary sinusitis or pleural/pulmonary inflammation, although the results were not statistically significant. Differences between tobacco consumers and non-consumers in the London group were not apparent, but the odds of having maxillary sinusitis increased by two-fold in middle adults (compared to young adults) and lower socio-economic groups (compared to higher socio-economic groups). Significant differences in respiratory disease frequencies were apparent between rural and urban groups. The results highlight the complexity of factors affecting upper and lower respiratory disease, indicating the potential impacts of not only tobacco consumption, but household, environmental, and occupational air pollution, as well as poor water sanitation, on frequencies of respiratory disease in different population groups.