 Thank you very much for listening this afternoon to the talk about a fascinating project that I was very fortunate to work on with my colleague Gaina Weston. It is entitled Manufactured Bodies, the impact of industrialisation on London health and it really stemmed from an earlier project that Gaina and I had worked on previously and Gaina had the super idea for expanding it to look at the bigger picture of the impact of industrialisation because we were able to have greater numbers of skeletal collections that we would now have access to. We were very fortunate to be awarded the Rosemary Green Grant through the City of London Markological Trust and this was really fantastic because it enabled us to be able to carry out a project because it's very important to be able to have large skeletal samples and data sets and also it was possible with the advent of access to osteoarchaeology for digital radiography to be able to actually implement that and apply that to the skeletal 3D modelling and to ultimately bring with it really a synthesis of the osteological data, clinical data, modern records and documentary sources that could then put everything into context so really to contextualise it so it was a fabulous opportunity to be able to carry out a project and undertake a question of this scale. Starting really with the Museum of London was key because the museum is very fortunate to be able to create and look after over 20,000 skeletal remains that have been excavated, 20,000 years history of London and a really unique representation of the people themselves and how they're sharing their life history and their life course through their bones to tell us about the life that they have led. What's also key is that we have the contextual information with them and this really helps enormously because that allows us then to have information with regard to how they're buried, burial type artefacts that may have been with them and the dating process which obviously is very key and for us to be able to know the time period that they're from. With the osteological data what has been really marvellous over the last few years is that we have standard methods now for recording and again this is really key so that you have confidence when you're going to your data sources that we're all then recording in a similar standard. For us we had the database and this is a brilliant research tool because it holds large amounts of data and it enabled us to actually search those data sets. Because of the large number of the skeletal collections we could also then have a very large sample to go to collect our sample sizes for our study so the museum was a brilliant repository to be able to start from. Industrialisation is really very pivotal within history and key to London's rapid expansion and for many it really is seen as being like a trigger to the modern way in which we live and what we know as the industrial period. So the area that we were looking at in the time period was covering really from 1750 to 1900 and this particular time is dominated particularly in terms of seeing changes within manufacturing processes, mechanisation, increases in population sizes. The population of London had always been very large but it was forever expanding and getting much bigger and putting more pressures upon the society with it. By the 1700s it was in fact not only the largest city in Europe but you also have half of England's urban population actually living within London itself. What was very noticeable as well is that we have these very marked social divisions which then equally have a great impact upon it. So it's a really enormous metropolitan urban metropolis and also is one of the largest ports and you've got lots of trading so everything really is big on a large scale. For the project itself we wanted to have a geographical distribution because we wanted to be able to have a comparison so when we were talking and looking at London we had others and so that was really key for having that ability to be able to compare and contrast. We also for trying to see changes wanted to have groups that would be seen to be pre-industrial and industrial so that again you're able to pick up any patterns and trends. We were trying for a target of 2500 individuals which was a large sample number to try to achieve and we did rather well. We got 2241 because it can be quite difficult sometimes accessing sites and collections with large numbers. Within our project we were only looking at adults and we only were including adults where it was possible to have an age and sex estimate and we had this so that we were then able to have cohorts of individuals grouped as being young, middle and old. And when we're thinking about archaeological material it isn't always complete and so this was something else that we had to factor in and for us we were looking for individuals that were at least 70% complete or more and had a moderate to good preservation so that again we're not then being affected too much by factors of postmortem damage or interventions. And this was used also in terms of our crude prevalence rate. For the true prevalence rate we had a skeletal inventory and that had a particular criteria of the completeness of individual elements that would then be used in working out the different rates in terms of the diseases that we would be looking at. So we were looking then at a combination of data sets, we were using our archaeological data, our osteological data, we were bringing in historical records so we have census records, bills of mortality, we're using environmental data from present day and modern clinical references. So again all to bring in that richness of contextualisation to the whole study for then looking to answer the questions is to show the variety of locations that were outside of London. And that was key so we really did need to have that comparator for all different types of sites, all different types of locations. And they could be rural, they could be small towns, they could be sort of close to the edge of cities but it was so that we were getting a really good sweep and range of all of the different sites. So we might have something like Fuston, which is quite small village but had a big mill associated with it. We have Bath and Humber, that was important for trading and then we have somewhere like Warren Percy where we have things that wax and wane, they maybe get smaller, they get bigger and there's lots of things that are actually changing within the make up of them. It was really key that we had that variety and so these sites outside of London, they were diverse and they were distinct from London so we have that lovely contrast. So in London, with this map you can see the sites that we were looking at. Again we had a really good range and a nice spread across London, different locations. And also what was interesting with our London sites is that it was really possible within those to see a structure of status so we were able to see that social status. In London sites, some of those could be class almost as being rural villages so as you're coming out more of what might be deemed as the city itself. So somewhere like Chelsea is rather green and lovely and associated with market gardens and so you do have this really nice rich variety. So again it was all for comparison and contrast and then also key when we're looking at those social structure changes. And something like that was very evident when looking at the documentary sources so here with the booth poverty maps. We've got two contrasts. On the one side you can see Victoria Park, Mylend and Bethel Green and we actually had a large collection from a burial ground in Bethel Green and you can see with the colour coding. How it highlights that difference. So when you have on the one side you've got the much darker black and blue where it's casting them as lower class, vicious, semi-criminal, very poor, casual and chronic want. To the other side where we have the district of Chelsea, which has much more of the yellow and the red and the pink, where it owns an upper middle class to wealthy. And we also had a group of individuals that had been buried at Chelsea Old Church. So this was really brilliant as well because we had this documentary evidence but we also then had individuals that were buried in these areas for reflecting these differences. The chart here shows us the skeletal demographic profile from our actual skeletal study and how then the individuals are grouped. So for our young adults we have 18 to 34 years of age and an old adult was 50 years and over. And so sad to have these ranges because again we're using data from different sources and so this then enabled us to group them collectively into our cohorts for the young middle and old age. So our areas of research we covered five themes and we wanted in the synthesis of the oesological data to actually then make it so that it was pertinent to topics and issues that are relevant today. And the areas that we covered in relation to that were trauma and hazardous environments which may be in relation to where you're working or living, pollution, cancer, obesity and aging. And with that it was bringing in and drawing in all of these different data sets. So the oesological research that had been done, the digital radiographic archive that was generated, the CT scanning, the records, again all of that lovely contextual information. And all of that was then linking in so that we could then compare and contrast what we might be seeing in terms of the health of Londoners across pre-industrial to industrial. To industrial time period. And with that it gave us a much better sense and understanding of the relevance of the role of your living so where people were living, whether that be in a location within London or further afield outside of London and then within your local settings. And so really then the key question is well how does living in London affect the lives in the past and how has that continued to do so today. In looking at that, we decided to look at seven diseases. So the concept of that research, we looked at these because they seem to be linked more association with things like industrialisation and enriched lifestyle, urbanisation and old age. And so the ones that we looked at were hyprostosis from Tarlis in Turner, which thankfully can be shortened to HFI, osteoporosis, joint disease, trauma, neoplastic disease, lung inflammation, which could be for us looking at rib lesions and maybe linked to smoking and diffuse idiopathic skeletal hyprostosis, which is shortened to dish. And you can see from the images. These are some of the things that we might see macroscopically. So these bones are showing the changes that we can see with our naked eye, but by using our radiography we've also then able to look inside them. So we have that combination of the two. And then you can see that we've got a rather splendid gentleman with his pipe. So when we were carrying out the project and thinking about the radiography, nothing in terms of radiography had been done on this scale. So it was a really large undertaking, but we had to then think about constraints of time, what's going to be possible in the time and where you might be located. And so it was to target key areas of the skeleton that would then be representative of different types of diseases that we might see throughout the skeleton. So we then decided to radiograph the crania, the lumbar vertebra, the left femur, the left and right pelvis and the left and right second metacomple. By having that suite of elements, even if not every single individual that we were able to find had all of those elements, there was the chance that we were then going to be able to pick up the different disease patterns within the elements that were present. So what was really fabulous was having a portable digital radiographic kit. This was really brilliant because in the past, trying to carry out radiography was either trying to use wet film and maybe a machine that looks a bit like a microwave oven and you can't get a femur in it, or having to travel around with boxes of skeletons to a hospital and use a kit there. This kit being portable meant that we could take it to the skeletal collections and we set up in the rotunda. So the picture you can see there of that rather lovely concrete wall is the rotunda. And we spent many days, generally always cold, carrying out the radiography and it was to use direct digital radiography. So when it was taking an image, that image was directly being fed straight into the computer. And we followed clinical standards and these are known as DICOM digital imaging and communications medicine because their mechanisms that have been used globally, they can store, you can exchange images, you can transmit them and it's used in the clinical field. And the operator of the kit was a radiographer and this also was very important so that we again were following good standards and good protocol. The image of the cranium you can see is on a left lateral position and again we followed that we would always take the elements in the same position so we had that consistency and continuity. And when we then came to look and evaluate the x-rays and interpret them, we were also fortunate to have the assistance of retired radiologists who fortunately had come to volunteer at the Museum of London. So we now have an archive of over 16,000 digital radiographic images which has been phenomenal for the project and then hopefully also can help other researchers in the future. So one of the areas that we were looking at was the occupational hazards that may be encountered. So it always is increasing and in a period of 100 years it increased by 3.5 million and continues to rise today. We're aware of different risks that have been faced in the past so when we're looking at rural areas we can see that there's a high risk from agricultural agrarian roles that people would be carrying out. But then when we begin to go into the more mechanised periods of time with machinery, then there's a really marked increase in the hazards that the people working on such equipment were faced with. And also some of the really nasty toxic environments in which they then may have been. So they may have been really close quarter working very cramped nasty conditions and dust particles as well. It seemed that it was often more male dominated in terms of working with the machinery, having that skilled labour and with heavy industry and construction. So very sort of hard physical work. Low status females were still working in those sort of environments in that industry and manufacturing. But they also could be found then doing piece work from home. If you were in a middle class situation, you might not then be involved in that physical side so much, but then maybe doing more roles in relation to things like the retail or bookkeeping. And within industrial London, you do tend to see this distinct setup of roles that are coming into the workplace. And unfortunately, retirement was rare. And as we go forward, people might feel that retirement is getting rarer as well. So when we were looking at actual bones that were then damaged, so we're looking at fractures, we then looked at the selective bones from all of the different time periods within the groups. And that was so that we could then assess to see if there were any changes in the fracture patterns over time. Could it be that maybe we can see and work it in terms of relation to a work role or occupation? And bearing in mind also things like sports. Sports in the past could be really rather violent. Didn't really have any regulations that we have now. And something like mob football was really very violent and people could get very seriously hurt. And there could even be deaths. So people didn't seem surprised if they were involved in something like that that may then cause their demise. And also there are coroner's records. And some of those can be really rather harrowing and distressing and sad when you read about some of the accidents and incidents that have happened to people in the past. But one that really stood out that Gaynor found, unfortunately was somebody that is recorded as death by cheese and can't say that it's because they ate the cheese. Unfortunately they were on a cart and those really very large cheeses rolled off and they were killed unfortunately in that manner. So when we're thinking about the types of fractures and trauma in the skeleton, usually they're caused mainly because of falling or having a blur. Elderly do tend to be more vulnerable. This could be linked because then they are older and potentially more fragile. But also that as you've got older, it's maybe more likely that you could then accumulate more fractures. So when looking at the actual groups and samples of individuals, it was to combine the young and middle age groups and then look at the old age groups. And it was to enable the assessment to be done in terms of relating biologically to age and sex. And what was also important was when we were looking into the London population was that we could also then examine the fracture pattern in relation to the social status. And when we were using clinical data that then enabled us to infer about the nature of the fracture causation in the past. So again, it was bringing in all these rich different data sources that we had available to us. So when we actually looked at the patterns that were revealed, the most common anatomical area that was affected was the ribs. And then the next was the hand or lower arm. And for London, the fractures did seem to be very much in specific areas in the ribs and hands. And that may then relate to the roles that males possibly had been doing during the industrial period. So it might then link into the actual sort of occupations and hazards that they faced. The least affected bones in the majority of the groups appeared to be the humerus and the femur. And we found a very low level of actual femoral fractures, so thigh bone fractures. And that could then indicate that there was less high impact accidents during that time period in the past and even during the industrial period. And potentially maybe what's key with something like that is that it's actually maybe more related to the speed and high velocity impact injuries that we might see something like the femoral fractures. And with cranial injuries, we did see them and we would see them either as a blunt force or sharp force, but they were relatively low in comparison to patterns that we would see today, which are usually a higher rate. So this 3D model image is of a crania of an individual and you can see the arrow pointing there to the aperture and that is a sharp force trauma and it's got rounded edges and so this person actually survived that really very nasty injury. But when we're thinking again in terms of injuries like this with sharp force trauma, we're also then thinking about things like interpersonal violence, the type of violence that we may have seen. There are records of violent murders in London, but we may not always see those reflected in our skeletal evidence within our cranial injuries. So we have to just be aware sometimes that we may have some limitations in what we're seeing, but for sharp force trauma generally, we had similar rates over all periods and all locations. So ultimately, when we looked at it collectively, the industrialisation of London really did have this significant increase in fractures and really what was key was social status and that for low status males and females in London, they had a much greater risk of experiencing trauma by the time they'd reached an old age. Higher status in the industrial period appeared to be a buffer effect and there seemed to be a reduced risk of fractures for males and females in London at that time. Interestingly, when we look at the sites outside of London, we then see an increase in trauma, but it didn't then seem to be linked necessarily to industrialisation. And that may be again because they were already potentially within doing within the agricultural and agrarian lifestyle in which they were living and working. The next part that we looked at, or just before I go on to that bit, if I can just go back, what I just wanted to say was that in one of the documentary sources was that spittle fields, bow and north shield had the three highest rates for violent crime in 1851 to 18 and middle aged adults. So again, possibly that might be a pattern today in terms of some of the younger individuals that are doing the violence and crime. So going back then just talking now to our next area was about pollution and pollution does take on many different forms. There might be a whole variety of different particles that could be within the wider environment itself, the environment in which we live. So if we're then having burning of coal or wood, which may be indoors in fires or for cooking, and then particularly within pre-industrial London, you have the burning of sea coals, which seem to be particularly noxious and not very pleasant at all. And then lifestyle habits such as smoking and also thinking about the environment in which people are working. So what type of things they might actually be inhaling from the manufacturing process and where they're working, the conditions again in which they might be. So if it's not very well ventilated, if it's a very small area, you've got dust and you've got very nasty particles. In earlier records, it would seem that London wasn't too bad in the early medieval period, but it does seem that from about the 13th century, there are indications that they were aware that actually the problem with pollution was beginning to occur at that point. And then as we go on in towards the 16th and 17th century, we have John Evelyn, who actually writes the fumifugium or the inconvenience of the air and smoke of London dissipated. And John Gaunt in 1662 in his pamphlet has actually done an analysis of mortality within the city and then has actually said that he's suggesting air pollution from burning of coal is a problem to public health. So this overall concern to everybody's health generally. And then see when we have the introduction with tobacco and the manufacturing of pipes and James the first wasn't very keen on smoking at all. And he's noted as saying that it was a custom loathsome to the eye and he tried to regulate the trade of tobacco and the manufacturer of pipes in one area, but it didn't last for very long on the superseded by Charles the first. And what's quite staggering is when you look at records in relation to the London docks in the 1840s in the one of the warehouse that the tobacco was covering over five acres. So huge area. And then again once we get into mechanisation and mass production, you get machines then just churning out lots and lots of cigarettes. And then you've got more people having access to it lower status. It's cheaper. So more people then are potentially carrying out that habit. As we move then on further into the 1950s, we have the great smog in London, which was really awful. People couldn't see really the hand in front of their face. It's a sort of peace supers, but really very dangerous to people's health. And it's been noted that about 4 to 12,000 deaths as a cause of that. It ultimately led them to the Clean Air Act of 1956. But sadly, we still seem to have pollution problems today and it's still very much on the agenda of trying to make our air clean. One way for us when we're thinking about our skeletal material and how would we look at something like a pollutant is looking at ribs. And with these we looked at the inner surface of the rib. So we looked at the visceral surface of the rib and these are known as VSRL, visceral surface rib lesions. You can see there on the picture the slightly darker brown colouring, and that then is a response to an irritant and inflammation. So it's causing that change that we can then see on the bone itself and that surface is adhering to the lungs. And that data was collated for all of the different time periods. We were aware that of course there are many other things that might cause reblesions and obviously we're aware at that time something like tuberculosis is very prevalent. But this was an indicator to tell us that something then is causing that irritant and we can look into that in relation to pollutants. So on this graph you can really see that the London industrial population was really struggling with pollution. It wasn't very good at all, and they had very high rates of these rib lesions. And actually you can sort of see that as an incredibly stark trend for London, where if you're looking at pre industrial period it's 2.9% with our rib lesions and going right up to 19.5%. So a really major increase and really putting an order strain upon the actual individuals that are then living in an environment like that. Ultimately when we're then looking at it in terms of with the males or females it was the young males in lower status who seem to be more affected and that again could relate possibly to the roles that they were working in. And again the sort of environments that they were having to be with social status was was key to this. So if we again think about some of the areas of London, you've got overcrowding, close quarter living, lots of nasty not just air both within living and working conditions so you really are not doing very well if you're in that lower status group. When we looked at smoking are indicated the smoking or what we would call pipe for sets little sort of notches in the dentition. And when we looked at that we really couldn't see a significant relationship for smoking and the presence of rib lesions. And smoking didn't seem to be really an important factor as much as the environmental pollution because that was so poor that actually smoking didn't seem to have much effect upon it. However today smoking obviously is much more key and critical to that and does have very marked adverse health effects which can lead to diseases such as cancer. So London unfortunately is still suffering from poor air quality. It's of great concern. It's very noticeable in its connection to cause of mortality and particular pollution is actually seem to be a greater threat today than smoking. And it seemed to actually have a measured effect in shortening life expectancy. And so as you can see there it's 1.8 years so shortening our lives by having such poor air quality. And from our analysis as it says there at the bottom in relation to the skeletal remains of the Londoners is that air pollution during the industrial period encompassing atmospheric pollutants occupational dust and contagious lung diseases posed a dramatically high risk to health compared to areas outside the city. So London really was being much more affected. So cancer was another area that we looked at and people today are very much more aware of cancer and for many maybe they think that it's a modern disease. And unfortunately cancer rates are increasing and it is seem to be as epidemic in modern Britain. The most common cancers that are seen are in the lung and the bow and the breasts and the prostate and they comprise 45% of all cancer deaths and individuals that are most frequently affected by the more older individuals and usually who are 75 years and older. And it is the second most common cause of death in London and there's been lots of research carried out in relation to cancer and it does appear that lifestyle environment are key factors in the cases of cancer and quite shockingly there it's got 90 to 95% in relation to that. So there are of course many different factors that might lead to your risk of cancer. There may sadly be genetic predisposition. It may be then a job or role that you were involved in. So there are different factors that need to be considered. Detecting cancer in the past can be difficult. Maybe they may then have recorded it. So the terminology, the referencing. So for us then to be able to understand maybe what they're then actually writing and recording is cancer. There was an awareness in the past with Greek medicine. There's references by Hippocrates to it and in medieval texts they talk about changes that are actually visible on the body. So again, they would only be able to actually talk about those changes that you'd be able to see with your naked eye. There would be very limited interventions that they could do, but clearly by having evidence such as this it isn't a new disease. It is a disease that has been with us, but then there are potentially changes that may then have caused it to seemingly increase more greatly now. In the Victorian period you begin to see more medical interventions and developments of treatments. And in 1851 you see the first cancer hospital to specialise in dealing with cancer, which today is known as the Royal Marsden Hospital. For us when we're looking at our skeletal evidence, for us we're restricted to actually looking at those cancers that will affect the bone and that's known as metastatic bone disease because we don't have the soft tissue. We're then relying on what we might be seeing changes in the bones themselves. Before cancer it was very important as well that we had that radiography ability because we weren't always necessarily going to see changes macroscopically on the outside of the bone. There may be changes going on inside that we wouldn't have known about if we hadn't been able to carry out the radiography. So having the x-rays was very important. By doing the radiography and the CT scanning it meant then we could look actually inside the bone to see any changes and also to be able to distinguish between what might have been post-mortem damage or soiling to what actually was a true disease change. And we were then screening and looking for metastatic cancers and multiple myeloma, which is a blood cancer, is clinical criteria, so again able to use clinical protocols. But we also mindful that cancers may then be developing in the past in potentially different ways. And there would be limited treatment in the past and a poor prognosis. So we may not obviously see a clear representation of all individuals that may have been affected by it. But fortunately today with different modern treatments they're making huge advances and then prognosis is usually greatly improved. So you can see here from the table quite starkly how things have changed over time. Within our project we only had a small natic and multiple myeloma. But overall by looking at that the percentage of the metastatic cases definitely did increase over time. They were in industrial London and so clearly that must of them be correlating to having a negative effect in terms of that urban environment and urban condition. And with the levels of metastatic cancer and multiple myeloma they are much higher now in modern times than in the past. And you can see this quite clearly in the table where you've got the breakdown of individuals from our groups and then into the present day. So another part that we were then looking at was into obesity. So they're seeing that and larger and that obesity is increasing, type 2 diabetes is on the rise. And with that excess weight that leads then to this inflammation and a dysregulation of insulin and the changes that they see then in the numbers of people type 2 diabetes and hyperinsulinia. So again it's another area that causes great concern and puts pressure on to the health system. With the skeletons of course we have the bones so it's quite difficult to then try to work out if somebody may have been overweight or obese. And there were two potential means for detecting that by looking at two diseases and that was dish and HFI. And in relation to Dave they talk about a thing called metabolic syndrome where they're looking at co-occurring conditions and that might link to things like an excess amount of fat around your waist. You've got a high blood sugar rate and that can then link in when they're thinking about stress genetics or more sedentary lifestyle. We aren't really as active as we were and greater alcoholic consumption. So it could be then that with us in the past looking at dish and HFI they equally can then feed into this aspect that's known as the metabolic syndrome. With dish you get this proliferation of bone forming within the soft tissue in ligaments and tendons and you can see in the picture there where we've got the vertebra, the spine. It does look like dripping candle that so you've got this bone that seems to sort of just drip down from one vertebra to the next and you become quite stiff. You get the ossification in the ligaments and it does seem to have a predisposition for older males and we see it quite regularly within our skeletal assemblages. When we're thinking in terms maybe more with relation to females is the hypostosis frontalis internaud, HF's bone growth on the inner surface of the cranium on the frontal bone. And this is where again the x-rays were really important to have because the pictures that you can see there, they are damaged crania so we can see inside them. But if you've got complete crania you can't see inside so we wouldn't know if maybe HFI was present or not. So that enabled us to actually look inside and get a much better indication of prevalence rates and the stages going from A to D can be quite small and proliferative to really large scale undulations. And when we were looking at it, the most common occurrence with it was in post-menopause women and generally those with a severe type do seem to be obese and have hyperandrogenism, which is the excess of male hormones. So they do definitely addition HFI seem to link into this being overweight and obese. So on this table here we can see comparative rates in relation to dish and HFI. Being overweight and it was certainly influenced by high status as dish. And at this time also we're thinking industrially that we have a really increased sugar consumption, very different levels of diet and foodstuffs particularly with our high status individuals. It seems the males were always seemingly overindulging themselves but the females gradually seemingly as you can see in the chart were catching up and then seeing those changes with HFI. From records there's information in terms of sort of banquets and feasts and lavish food and very rich diet so all adding to the effect of making individuals more overweight. In terms of when we're looking at modern population what was really very interesting is that we had a reverse of the past. So in today modern population, those that are most affected seem actually to be suffering from social deprivation so it's sort of in a complete sort of turnabout. And it really is a marked variation across the locations nationally. And interestingly with London London has very different pattern it seems to other areas outside of London and they have much lower prevalence of the excess weight in adults and type 2 diabetes. And also with the social divide. So again in London with the highest status you seem to see individuals that are not likely to be overweight or obese and have type 2 diabetes but you do start to see those patterns within less affluent boroughs and low status locations and equally when we're looking at areas outside of London. For the population today as well it does seem that older males there tends to be this prevalence of the obesity and type 2 diabetes to increasing. And again in looking at the figures in modern population. It is this link again to the processed food that individuals are eating. There's a high sugar consumption, probably not as active and higher alcohol intake so a whole plethora all sort of feeding in literally to one another for creating this problem of being overweight. The last area that we were researching was in relation to getting older and today we do all seem to be living to be older but it is seem to be a global phenomena and governments around the world are really rather concerned with an aging population and the impact that has upon them. But what is old age really the perceptions of age has probably changed greatly over time. We might see it as lots of teeth or our hair going grey or getting wrinkles, but it can vary enormously from, you know, different individuals and different parts of the world, and also socially, what was the perception of old age. The problem we tried to look at that really the information that was available related more to mail it is, and things such as the statute of Westminster from 1285. And that was related couldn't then be a juror anymore, and the statute of labors of 1349 noted that once you reach the age of 60 there were possibly some tasks that you wouldn't be able to do. So there was a sense of a certain age, but some people may not have even known how old they were. So these are all factors that we have to consider and does make it difficult when we're trying to estimate life expectancy in the past. So trying to use other means to help us the bills of mortality are very interesting records and relate to burial records but they do then give age information. And when we were looking at those from the 1720s to the 1850s, there is an increase in older age individuals and that increases from 45% in the 1720s up to 53.7% in the 1850s. So clearly there is an improvement. The census records are good and are often more accurate, but they can still have limitations. And then we can bring in other documents to help us as well. So there was the Edwin Chadwick report that was looking at the sanitary conditions of laboring population of Great Britain. And what's very noticeable there again is that difference in terms of where you are in location in London. So in Bethnal Green at 16 years of age, and then if you were living in Kensington, your life expectancy then is 26 years. So very noticeable difference then socially. We begin to see a marked increase in improvement really from 1870 onwards and then again after World War II and the inception of the National Health Service. The life expectancy trajectory has just continued to grow. And in 2014 to 2016, the average age life expectancy for males was 79.2 years and for females was 82.9 years. So there definitely is this trend for us all living to be older. But we then need also to consider that there are different factors that might affect life expectancy, both in our pre-industrial and industrial areas. And we can look at things like famines, we can look at disease profiles, public health measures that are brought in to affect everyone as a whole. And again looking at the environment and social conditions, which are really very key and how then in terms of London, the London age structure can then be seen at different times to be very different. We are trying to estimate an age in our ocellurgical data set. We do have difficulty in the accuracy of them. So there are limitations with these that we then have to bear in mind. We aren't able to give a specific age to an individual into. And because of that then there do appear to be fewer old age individuals that we might then identify in our ocellurgical records when comparing to burial records with coffin plates, and they then give us that accuracy of the age of death of an individual. And within our study group, we did fortunately have a group of individuals that had that data. So that was really helpful when we were then looking in relation to old age and those patterns. There were significant differences when looking at the age profiles that we were obtaining and comparing when we had our documentary information to those from our skeletons. And it really was very clear when looking at data source from 1851 to 60 with the mortality data that they really are underrepresented in terms of the skeletal assessment compared to the data. And couldn't resist putting in the lovely wax model of Marjorie. So we might perceive that people weren't living to be very old in the past, but here's Marjorie at 108. So when we're thinking something about age, we're also then thinking about diseases and one of the diseases that will be associated with age is osteoarthritis, the degeneration of the joint structure. And clinically, it is seen that women have higher rates of it comparatively to men. They will often have a more severe form of the disease as well. And there's a difference in the onset of it between males and females. So for men, it's usually before 55 and for women, it's over 50. And this association and link with the menopause and the change in estrogen. When they're looking at patterns in terms of diseases, there does seem then to be a pattern in that women seem to be more affected with knee osteoarthritis and males in the hips. And when we looked at our data sets, there was an increase in the osteoarthritis over time in both our London groups and outside of London. But there didn't seem to be any significant difference in the knee osteoarthritis with the females over time. And there wasn't really a significant difference between those of low or high status for male or female in any of the age groups. The other joint that we looked at was the knee. And there seemed to be consistently higher rates outside of London for both the pre-industrial and industrial. And there's something like this that might again be in relation to occupational bearing and linking it again to physical activity. But overall, the actual rate for hip OA did increase within London. And interestingly, the high status females, they seem to have less hip OA to the lower status. And again, that maybe could be a buffer to possibly what type of roles they may then have been doing and load bearing. But interesting as well overall for the pre-industrial rural populations, there were always considerably higher rates within the middle age category. And again, we were thinking that could be very much linked to the agricultural lifestyle that they were leading and the working and living environments in which they were. Osteoporosis is a disease again that probably a lot of people have heard of now. They associate it with individuals who are older. It affects the quality of the bone. It makes it more fragile. It is much more vulnerable to fracture. You hear about individuals fracturing their wrists or their hips. And when we're looking skeletally for osteoporosis, we will be looking for those sorts of patterns to see which elements then may have been affected. But there are a number of factors that can affect osteoporosis and it isn't just age. So it could be linked to something like malnutrition or maybe a disease such as cancer or treatments that an individual may have in modern day. There are clinical methods for them to carry out scanning and screening in relation to osteoporosis. And there we see them in decks and radiogrammetry. And the application of radiogrammetry we were able to do because of doing the digital x-rays and having x-rays of the second metacarpal. So this was absolutely brilliant for us to be able to apply a technique that they would be using clinically to see if we were getting individuals with osteoporosis. So our sample was a large sample. We had 1,032 individuals. They covered all the different age ranges of males and females from all the different periods. We used the second metacarpal, the bone in the hand, and only used those that were complete that hadn't had any post-water damage. And we did measurements and calculations so we were looking at the metacarpal cortical index. And we followed the two studies that provided scores that we could then use against scores we were reaching to identify if an individual was osteoporotic or had osteoporosis. What was really interesting is that the highest rates were coming out with the metacarpal index in our old age adults and particularly so in old age females. Perhaps now maybe today that's not unsurprising. And with the females, the rates did increase with age. And for Londoners as well with old age, they had the highest rates within the industrial period and really almost double 21.8% compared to the non metropolitan areas at 10.5%. And they are obviously affected more by those changes and we see that throughout industrial and pre-industrial period. What was interesting was in the period industrial period, we were actually picking up quite high rates of the osteoporosis in younger middle aged adults. And that's not something necessarily that we would have expected to find all that you'd expect to find today. And we found those notably in the group that we looked at from Mary Spittle, which is a medieval site. And we know that had been the burials of individuals that had been affected by famine episodes. And you have different burial types. And it was those that were in the mass burials that were more affected. And we found in those mass burials that osteoporosis was found much more significantly in the young female adults. And this then we were thinking could be linked to those episodes where you've got climatic change, poor harvest, malnutrition, famines. This actually is affecting those individuals, mothers, babies. This is having quite a profound effect on an individual. And therefore you are seemingly prematurely aging. And it's because of this result of these intermittent periods of malnutrition. And so ultimately now when we look at it, really the process for us physically of growing old really has a markedly changed. And some of the diseases such as osteoporosis or ostearthritis, we might see those now relating to age, but that isn't necessarily always the case when we're looking back into the past. When we were looking at old age, they did then seem to be a wallstone increase over time, but there were other variation. So you have that movement away from rural to urban centres. This can then affect your demographic profile and that can change in pre-industrial and industrial. And often it's the young moving away to seek work and they will move into cities and that then will affect the communities that are then left behind. And this trend of old age individuals we were picking up within that rural community was really present from at least 1851. And interesting as well, the effect on mortality, your status definitely had an effect upon that. And in terms of modern populations as well, your economic prosperity is definitely linked to an increase in your life expectancy and any rates of premature death. And if today you may be living in Kensington or Chelsea, then you can expect to live 10 years longer. So there definitely is that that interlinking. And there is, as they note from statistical data, still this graying as they call it of the countryside. So when we were writing the book, it was just to say here that osteological study of human remains using the latest imaging technologies repeatedly highlights the importance of the local environment. And ultimately the social status that goes hand in hand with it for an individual's health and life expectancy, both in the past and present. So that local environment really is key and your social status. It's all really interlinking into your health and life expectancy. So in conclusion, the industrialization of the city really has been a bit of a salt on the health of Londoners. But what we saw was that it wasn't something that was uniformly happening across all areas and all communities. There were differences. And within London as well, particularly in industrial period, you do see this division according to your age and sex. And you can say as well that with the public health measures that there are both positive and negative of age and ageing and age-related diseases. They are closely linked to the different lifestyles that you may have, your economic status. And then the numbers that we see affected by diseases we might associate with age today. Again, we're having distinct patterns across the country. But what really is very key is the environment. The environment is important at all levels. It is interlinked to us to the human body. It's influencing us and also that genetic link. So all of those things are connected and they're shaping us both in the past and the present and the future. And so lastly, if just to read another quote just from the book is for the present time, the evidence we have amassed here using digital imaging from largely agrarian rural lifestyles to those based on heavy industry and technology has left a deeply embedded imprint on many aspects of our health in London and the wider UK today. The biological changes we observe in archaeological human remains are a testament to how we are responsible for manufacturing our living environments and our bodies as a result. And so just for me to say thank you very much to everybody who very kindly supports just all our archaeological colleagues, our osteological colleagues, and of course again to Colat for very generously funding the project. And I believe that there is a discount for the book and I know everybody obviously this is the best thing you can buy somebody for Christmas. It'll be on everyone's Christmas wish list. And then lastly for me to leave the slide there to say that the next lecture is on October the 29th. Elena, thank you very much. That was really fascinating and thank you very much. I get the sense that you've given us kind of the top level of data and there's an immense richness underneath. And so we've got some questions coming up in the chat if you would be happy to address some of those. And Katie Whittaker is asking about whether teeth were incorporated so dentition, condition of teeth into the parts of the study. We didn't look at teeth separately. The use when we were looking at teeth was when we looked at our pipe for sets for smoking. But teeth are a very important area and we're aware again when we're looking at things like sugar consumption, so caries. But that's another area that we would like to look at with the data sets and things like calculus. That's something that we'd be very interested in looking at but we didn't look at them specifically as an individual element. I mean particularly links with the sort of sugar consumption. I imagine that whole crop up. Yes. Katie's also asking whether you're able to make any links between the cemetery populations and specific industries in the areas where they might have been working. Well that's a very good question. Yes, when we did in our analysis I was saying we were looking at types of occupations that individuals may have had. So we would look at it more generally as if you were possibly then working in the agricultural area or if there was then a mill in that location. But we weren't that specific in that sense. So we knew individuals potentially within Fuston there was the mill. London we've got smaller types of outputs for different types of occupations or roles. But we weren't necessarily able to say these people from this site were particularly then connected to that particular occupation per se. It was more of a sort of general overview. Thank you. And I wanted to ask, obviously you focused on adults. Did you deliberately decide to exclude children for a particular reason? And did you pick up any kind of patterning with this school populations that you did look at? Yes, well again it was a case of what potentially might be available to us completeness and getting those large numbers and data sets. So we knew that we'd have a greater potential for having adult collections and looking at things like the pollution with the cancer. If we were picking out we would tend to maybe see that more within an adult, the trauma patterns. It would be then also linking with the completeness and the preservation. So it was that access to data and data sets. So trying to get other collections. London we're very fortunate. We have large collections. So you have greater job. But when we began to look outside that was more difficult with our numbers. And so again trying to get large sample sizes and particularly for industrial. So our post medieval they were really quite hard to come across the outside of London. So it was trying to sort of hone in and try to bring into the focus. So adults was the way forward. Okay. Thank you very much. So I think that's all the questions that we have had. So again, thank you. That was really, really interesting. I give notice that the next meeting will be on the 29th of October 2020 when we will hear a paper. The Antiquarian and Contemporary Exploration of Roman Orbara by Professor Martin Millar say and Dr Rose therapy. The meeting stands adjourned.