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Smoking may seriously affect your skeleton
Perspectives
The art of medicine Smoking may seriously affect your skeleton These two days past a fire has been kept up in the Customhouse yard, fed solely with “the weed” of native growth, very much to the regret of the sailors, porters, and the mobility in general, whose mouths are watering at “the waste of baccy”. Burning of Irish Tobacco, The Times, Sept 9, 1833
Such was the rancour among those with a well established taste for “baccy” when, in 1833, 20 tonnes of tobacco were burnt in the yard of Dublin’s customs house. This action was taken in response to a duty imposed by the British Government on the purchase of this Irish cultivated plant, the importation of which had become a threat to Crown revenue. Tobacco first appeared in Britain during the 16th century, but it was not until the 19th century that smoking found widespread popularity, with the mass production of cigarettes after the Crimean war in the 1860s. Before this, cigars and cheroots were available, although most British smokers consumed their tobacco in clay pipes. These pipes were disposable items, easy to make and often given away free with a pint of beer in the public house. The ordinary short clay pipe lacked the long stem of the classic design and was popular with labourers. Clenched between the teeth, short pipes allowed working people to carry on smoking with their hands left free for work. Thus, they were free to pursue their habit throughout the day. Now considered a global epidemic, cigarette smoking has major health implications and has been linked to particular social and economic groups, but it is not just from modern populations that we may examine such trends. Archaeology has provided fresh insight into the world of tobacco consumption in the 19th century. Excavations by Museum of London Archaeology, in advance of construction work, recovered more than 700 individuals from the former burial ground associated with the Catholic Mission of St Mary and St Michael, Lukin Street, Whitechapel, London, UK. Open for just 11 years between 1843 and 1854, this burial ground was soon full. Buried within wooden coffins, contained in deep stacks of up to eight individuals placed on top of each other, young infants were found at the top, older children below, and adults towards the bottom. Surviving coffin name plates suggest that many of the excavated individuals may have been of Irish extraction, some emigrating to escape the Great Irish Famine. By examining the marks of activity and health left behind on the skeleton, together with documentary evidence, it was possible to look in detail at the smoking habits of 19th-century Londoners, revealing the extent to which this particular aspect of life affected past health. Pipe-worn 796
facets or notches, in the form of smooth, rounded wear patterns on the biting (occlusal) surfaces of the teeth, are one way in which evidence of smoking may be shown in archaeological human remains. These notches often appear between multiple teeth and can reveal a well-defined circular hole when the upper and lower jaws are articulated. A result of the habitual practice of gripping a clay pipe between the teeth, just under a quarter of the 268 adults from St Mary and St Michael burial ground were found to have such notches. Brown or black stains were also commonly found on the tongue facing (lingual) aspects of the molar and premolar teeth. These distinct areas of staining were often seen together with pipe notches and might represent deposits released during the inhalation of tobacco, although further analysis is needed to see if it is possible to characterise the components of the tobacco that was being smoked. The great majority of the skeletons identified as smokers at St Mary and St Michael burial ground were male. Our comparison between the mortality profiles of males with evidence of smoking and those without revealed a higher death rate in smokers aged 26–35 years, suggesting that they might have suffered a lower life expectancy. There was no evidence of smoking in the skeletons of those aged younger than 18 years; however, a number of young adults with pipe notches might have taken up smoking before adulthood. Adult smokers were also frequently found with deposits of subgingival calculus, hardened plaque clinging to the teeth below the gumline. This suggested that smoking might also have contributed to gum disease. Periosteal new bone growth on the visceral surfaces of the ribs was also more common among smokers. While not possible to identify the specific disease that caused this inflammation, its presence might point to an association between smoking and lung disease. Rib lesions were far more common among the less affluent population at St Mary and St Michael than their wealthier counterparts from burial grounds such as St Marylebone churchyard, London. Lung disease within all classes of people would have been influenced by occupational activities and the local environment. However, the evidence we unearthed indicates that pipe smoking may have been more popular in adults from poorer backgrounds. Indeed, in literature from the time, such as Vanity Fair, pipe smoking is described as unsophisticated compared with smoking the cigar or cheroot. For many, smoking was regarded as a symbol of vulgarity in the poor labouring classes, a base activity that only gradually became accepted by the upper classes in the second half of the 19th century. www.thelancet.com Vol 379 March 3, 2012
How tobacco was consumed was largely determined by background, gender, occupation, and position. In some ways the cultural identity of the Irish Catholic population from St Mary and St Michael may have been reflected in everyday, habitual activities. The use of the same types of tobacco may have served to reinforce community ties and a sense of solidarity and security at a time of heightened anti-Papist feelings in London. As London began to swell through the influx of migrants, including Irish people, from rural regions into areas such as the East End, poor sanitation and overcrowding affected the health, living conditions, and life expectancy of the population. This contributed to the spread of infectious diseases that thrived in such impoverished urban slums. One particular disease that tormented the population at this time was tuberculosis (consumption); during the 1840s the disease claimed the lives of around 15% of Londoners as recorded in the Bills of Mortality. Recent migrants from Ireland might have had little resistance to tuberculosis on their arrival in London. In modern populations, smokers with subclinical forms of the disease are more likely to advance to the clinical stage and die of tuberculosis than are nonsmokers. Changes in lung environment or immune status may be a catalyst for this. Perhaps 19th-century smokers aggravated existing infections resulting in increased susceptibility to lung disease and a higher death rate in the younger adults. The harmful effects of smoking are now well understood, but an association between poor health and smoking was also recognised in the 19th century. As the historian Matthew Hilton has documented, physicians were concerned with the effects of tobacco consumption: John Lizars published his Practical Observations on the Use and Abuse of Tobacco in 1854 and “The great tobacco question: is smoking injurious to health?” was debated in the pages of this journal in 1857. Partly a by-product of the temperance movement, anti-tobacco groups, such as the Anti-Tobacco Society which was set up in 1853, may have sought to denigrate the working classes and migrant communities. Writing in The Times in 1860, one correspondent remarked how “A large proportion of habitual smokers are rendered Lazy and Listless, indisposed to bodily and incapable of much mental exertion”. However, as the habit became more popular, the restrictions on its use diminished. Towards the latter half of the 19th century, smoking was first tolerated in public railway carriages; it took a further 20 years for smoking to be accepted in the capital’s clubs. More than 100 years later the position was reversed, with smoking banned in many public places in Britain. For the population of St Mary and St Michael, the concerns of the anti-tobacco groups may have seemed trivial when compared to the trials of everyday poverty. Reduced life expectancy, high infant mortality, and high www.thelancet.com Vol 379 March 3, 2012
Museum of London Archaeology
Perspectives
Individual from St Mary and St Michael burial ground, Whitechapel, London, showing pipe facet
rates of childhood illnesses, such as rickets, infectious disease, and risk of serious injury though trauma, were all apparent in the archaeological evidence. Smoking might, therefore, have offered a small luxury for the labouring classes, a brief escape from the daily hardships of life. It is clear that culturally determined factors affected disease and mortality in the recent past. Evidence of social activity is notoriously difficult to extract from archaeological evidence, but habitual activities such as smoking can provide important insights into past communities. The potential benefits of the study of past populations such as this fascinating group of individuals from St Mary and St Michael can bring much to our understanding of health today. Studies of more recent populations have often revealed a link between smoking and poorer backgrounds. Similar patterns may have occurred in London during the 19th century. The presence of pipe notches and dental staining might provide an indication of social status, thereby increasing the potential of archaeological samples and enabling us to examine aspects of health and disease from a socioeconomic perspective. Evidence of this habit as determined from examination of skeletal remains may aid in the identification of the social position of a population.
Further reading Anon. Ireland. Burning of Irish tobacco. The Times Sept 9, 1833 Brodie BO. The use and abuse of tobacco. The Times Aug 31, 1860 Garwood J. The million peopled city or one-half of the people of London made known to the other half. London: Wertheim and Macintosh, 1853 Hilton M. Smoking in British popular culture. Manchester: Manchester University Press, 2000 Lin H-H, Murray M, Cohen T, Colijn C, Ezzati M. Effects of smoking and solid-fuel use on COPD, lung cancer, and tuberculosis in China: a timebased, multiple risk factor, modelling study. Lancet 2008; 372: 1473–83
*Michael Henderson, Don Walker
Solly S, Pidduck J, Smith D, et al. The great tobacco question: is smoking injurious to health? Lancet 1857; 69: 175–79
Museum of London Archaeology, Mortimer Wheeler House, London N1 7ED, UK mhenderson@museumoflondon.org.uk http://www.museumoflondonarchaeology.org.uk
Walker D, Henderson M. Smoking and health in London’s East End in the first half of the 19th century. Post-Medieval Archaeology 2010; 44: 209–22
797
The art of medicine Smoking may seriously affect your skeleton These two days past a fire has been kept up in the Customhouse yard, fed solely with “the weed” of native growth, very much to the regret of the sailors, porters, and the mobility in general, whose mouths are watering at “the waste of baccy”. Burning of Irish Tobacco, The Times, Sept 9, 1833
Such was the rancour among those with a well established taste for “baccy” when, in 1833, 20 tonnes of tobacco were burnt in the yard of Dublin’s customs house. This action was taken in response to a duty imposed by the British Government on the purchase of this Irish cultivated plant, the importation of which had become a threat to Crown revenue. Tobacco first appeared in Britain during the 16th century, but it was not until the 19th century that smoking found widespread popularity, with the mass production of cigarettes after the Crimean war in the 1860s. Before this, cigars and cheroots were available, although most British smokers consumed their tobacco in clay pipes. These pipes were disposable items, easy to make and often given away free with a pint of beer in the public house. The ordinary short clay pipe lacked the long stem of the classic design and was popular with labourers. Clenched between the teeth, short pipes allowed working people to carry on smoking with their hands left free for work. Thus, they were free to pursue their habit throughout the day. Now considered a global epidemic, cigarette smoking has major health implications and has been linked to particular social and economic groups, but it is not just from modern populations that we may examine such trends. Archaeology has provided fresh insight into the world of tobacco consumption in the 19th century. Excavations by Museum of London Archaeology, in advance of construction work, recovered more than 700 individuals from the former burial ground associated with the Catholic Mission of St Mary and St Michael, Lukin Street, Whitechapel, London, UK. Open for just 11 years between 1843 and 1854, this burial ground was soon full. Buried within wooden coffins, contained in deep stacks of up to eight individuals placed on top of each other, young infants were found at the top, older children below, and adults towards the bottom. Surviving coffin name plates suggest that many of the excavated individuals may have been of Irish extraction, some emigrating to escape the Great Irish Famine. By examining the marks of activity and health left behind on the skeleton, together with documentary evidence, it was possible to look in detail at the smoking habits of 19th-century Londoners, revealing the extent to which this particular aspect of life affected past health. Pipe-worn 796
facets or notches, in the form of smooth, rounded wear patterns on the biting (occlusal) surfaces of the teeth, are one way in which evidence of smoking may be shown in archaeological human remains. These notches often appear between multiple teeth and can reveal a well-defined circular hole when the upper and lower jaws are articulated. A result of the habitual practice of gripping a clay pipe between the teeth, just under a quarter of the 268 adults from St Mary and St Michael burial ground were found to have such notches. Brown or black stains were also commonly found on the tongue facing (lingual) aspects of the molar and premolar teeth. These distinct areas of staining were often seen together with pipe notches and might represent deposits released during the inhalation of tobacco, although further analysis is needed to see if it is possible to characterise the components of the tobacco that was being smoked. The great majority of the skeletons identified as smokers at St Mary and St Michael burial ground were male. Our comparison between the mortality profiles of males with evidence of smoking and those without revealed a higher death rate in smokers aged 26–35 years, suggesting that they might have suffered a lower life expectancy. There was no evidence of smoking in the skeletons of those aged younger than 18 years; however, a number of young adults with pipe notches might have taken up smoking before adulthood. Adult smokers were also frequently found with deposits of subgingival calculus, hardened plaque clinging to the teeth below the gumline. This suggested that smoking might also have contributed to gum disease. Periosteal new bone growth on the visceral surfaces of the ribs was also more common among smokers. While not possible to identify the specific disease that caused this inflammation, its presence might point to an association between smoking and lung disease. Rib lesions were far more common among the less affluent population at St Mary and St Michael than their wealthier counterparts from burial grounds such as St Marylebone churchyard, London. Lung disease within all classes of people would have been influenced by occupational activities and the local environment. However, the evidence we unearthed indicates that pipe smoking may have been more popular in adults from poorer backgrounds. Indeed, in literature from the time, such as Vanity Fair, pipe smoking is described as unsophisticated compared with smoking the cigar or cheroot. For many, smoking was regarded as a symbol of vulgarity in the poor labouring classes, a base activity that only gradually became accepted by the upper classes in the second half of the 19th century. www.thelancet.com Vol 379 March 3, 2012
How tobacco was consumed was largely determined by background, gender, occupation, and position. In some ways the cultural identity of the Irish Catholic population from St Mary and St Michael may have been reflected in everyday, habitual activities. The use of the same types of tobacco may have served to reinforce community ties and a sense of solidarity and security at a time of heightened anti-Papist feelings in London. As London began to swell through the influx of migrants, including Irish people, from rural regions into areas such as the East End, poor sanitation and overcrowding affected the health, living conditions, and life expectancy of the population. This contributed to the spread of infectious diseases that thrived in such impoverished urban slums. One particular disease that tormented the population at this time was tuberculosis (consumption); during the 1840s the disease claimed the lives of around 15% of Londoners as recorded in the Bills of Mortality. Recent migrants from Ireland might have had little resistance to tuberculosis on their arrival in London. In modern populations, smokers with subclinical forms of the disease are more likely to advance to the clinical stage and die of tuberculosis than are nonsmokers. Changes in lung environment or immune status may be a catalyst for this. Perhaps 19th-century smokers aggravated existing infections resulting in increased susceptibility to lung disease and a higher death rate in the younger adults. The harmful effects of smoking are now well understood, but an association between poor health and smoking was also recognised in the 19th century. As the historian Matthew Hilton has documented, physicians were concerned with the effects of tobacco consumption: John Lizars published his Practical Observations on the Use and Abuse of Tobacco in 1854 and “The great tobacco question: is smoking injurious to health?” was debated in the pages of this journal in 1857. Partly a by-product of the temperance movement, anti-tobacco groups, such as the Anti-Tobacco Society which was set up in 1853, may have sought to denigrate the working classes and migrant communities. Writing in The Times in 1860, one correspondent remarked how “A large proportion of habitual smokers are rendered Lazy and Listless, indisposed to bodily and incapable of much mental exertion”. However, as the habit became more popular, the restrictions on its use diminished. Towards the latter half of the 19th century, smoking was first tolerated in public railway carriages; it took a further 20 years for smoking to be accepted in the capital’s clubs. More than 100 years later the position was reversed, with smoking banned in many public places in Britain. For the population of St Mary and St Michael, the concerns of the anti-tobacco groups may have seemed trivial when compared to the trials of everyday poverty. Reduced life expectancy, high infant mortality, and high www.thelancet.com Vol 379 March 3, 2012
Museum of London Archaeology
Perspectives
Individual from St Mary and St Michael burial ground, Whitechapel, London, showing pipe facet
rates of childhood illnesses, such as rickets, infectious disease, and risk of serious injury though trauma, were all apparent in the archaeological evidence. Smoking might, therefore, have offered a small luxury for the labouring classes, a brief escape from the daily hardships of life. It is clear that culturally determined factors affected disease and mortality in the recent past. Evidence of social activity is notoriously difficult to extract from archaeological evidence, but habitual activities such as smoking can provide important insights into past communities. The potential benefits of the study of past populations such as this fascinating group of individuals from St Mary and St Michael can bring much to our understanding of health today. Studies of more recent populations have often revealed a link between smoking and poorer backgrounds. Similar patterns may have occurred in London during the 19th century. The presence of pipe notches and dental staining might provide an indication of social status, thereby increasing the potential of archaeological samples and enabling us to examine aspects of health and disease from a socioeconomic perspective. Evidence of this habit as determined from examination of skeletal remains may aid in the identification of the social position of a population.
Further reading Anon. Ireland. Burning of Irish tobacco. The Times Sept 9, 1833 Brodie BO. The use and abuse of tobacco. The Times Aug 31, 1860 Garwood J. The million peopled city or one-half of the people of London made known to the other half. London: Wertheim and Macintosh, 1853 Hilton M. Smoking in British popular culture. Manchester: Manchester University Press, 2000 Lin H-H, Murray M, Cohen T, Colijn C, Ezzati M. Effects of smoking and solid-fuel use on COPD, lung cancer, and tuberculosis in China: a timebased, multiple risk factor, modelling study. Lancet 2008; 372: 1473–83
*Michael Henderson, Don Walker
Solly S, Pidduck J, Smith D, et al. The great tobacco question: is smoking injurious to health? Lancet 1857; 69: 175–79
Museum of London Archaeology, Mortimer Wheeler House, London N1 7ED, UK mhenderson@museumoflondon.org.uk http://www.museumoflondonarchaeology.org.uk
Walker D, Henderson M. Smoking and health in London’s East End in the first half of the 19th century. Post-Medieval Archaeology 2010; 44: 209–22
797