Respiratory Diseases and Their Contribution to Understand the Human Past

By Maia Casna and Sarah A. Schrader

Over the past fifty years, the study of archaeological human remains has become an integral part of archaeology, as it provides empirical evidence of past individuals and communities. Within bioarchaeology, paleopathology developed as an important subfield focusing on disease as a means to understand how people's life experiences impacted their health in the past. Disease, in fact, has affected and will continue to affect everybody globally: it can not only cause our death, but also affect the way we function, as well as our relationships and our role within society. Therefore, exploring the health challenges our ancestors faced offers us a unique window not only into the lives of individuals, but also the development of past societies as whole.

In this framework, the study of respiratory disease (i.e., sinusitis, pulmonary infections) is of primary importance in the reconstruction of past lives. As the air we breathe can affect our health in many ways, studying respiratory disorders in archaeological contexts offers unique insights in how human living conditions, working environments, and behavioral patterns, such as smoking, influenced our wellbeing across time. Traces of respiratory infections on the human skeleton include inflammatory new bone formation or resorption within the paranasal sinuses (i.e., air-filled spaces that surround the nasal cavity) and on the visceral surfaces of the ribs (Figure 1).

Figure 1. Lesions on the ribs (A-B) and within the maxillary sinuses (C-D) linked to respiratory infections.

As pointed out by Roberts (2016), bone changes linked to respiratory disease are often subtle and therefore difficult to recognize either macroscopically or radiographically. This, together with the variegated etiology of respiratory disorders, has caused such conditions to be long ignored in bioarchaeology, despite their importance in the study of human disease. However, in recent years several studies have attempted to address such limitations and have generated appreciable results that not only attested to the incidence of respiratory conditions throughout human history, but also demonstrated their importance in dismantling common beliefs about past environments and their influence on human health.

For example, it was long believed that urbanization had negatively impacted human respiratory health as early cities have been commonly associated not only with air pollution, but also with negative factors such as overcrowding, poor hygienic conditions, and malnutrition. However, recent studies on sinusitis in post-medieval Europe have highlighted similar occurrence rates of sinusitis between urban and rural societies, suggesting that, while cities surely challenged respiratory health, adverse weather conditions associated with allergies and limited access to healthcare resulted in similar challenges for human respiratory health in rural environments as well (e.g., Bernofsky, 2010; Casna et al., 2021). Other recent bioarchaeological studies on respiratory disease have addressed the impact that climate change had on past societies, bringing up evidence of how processes such as aridification and desertification may impact our wellbeing and long-term health (Binder, 2014; Davies-Barrett et al., 2021).

Although bioarchaeologists have often been hesitant to include respiratory disease in their investigations, in the past three years many studies have started to focus on such conditions, exploring new ways of diagnosis as well as new interpretation of results. Alongside new methods being suggested (e.g., Davies-Barrett et al., 2019), new methodologies of analysis such as Computed Tomography (CT) and Air Quality Monitoring (AQM) stations in reconstructed environments are being introduced in the study of past respiratory health (e.g., Shillito et al., 2022; Zubova et al., 2020). New methods and data are not only demonstrating the complexity of respiratory disorders and their significant impact on human wellbeing, but are also enabling researchers to draw a number of transformative conclusions about the human past. Ongoing studies of respiratory disease will continue to expand upon what we have already learned, yielding important results that are applicable not only to the study of past populations, but also to other disciplines such as biology and clinical medicine.


Bernofsky, K. S. (2010). Respiratory health in the past: a bioarchaeological study of chronic maxillary sinusitis and rib periostitis from the Iron Age to the Post Medieval Period in Southern England. Unpublished PhD dissertation (Durham: Durham University).

Binder, M. (2014). Health and Diet in Upper Nubia through Climate and Political Change - A bioarchaeological investigation of health and living conditions at ancient Amara West between 1300 and 800BC. Unpublished PhD dissertation (Durham: Durham University).

Casna, M., Burrell, C. L., Schats, R., Hoogland, M. L. P., & Schrader, S. A. (2021). Urbanization and respiratory stress in the Northern Low Countries: A comparative study of chronic maxillary sinusitis in two early modern sites from the Netherlands (AD 1626–1866). International Journal of Osteoarchaeology, 31(5), 891–901. DOI:10.1002/oa.3006

Davies-Barrett, A. M., Antoine, D., & Roberts, C. A. (2019). Inflammatory periosteal reaction on ribs associated with lower respiratory tract disease: A method for recording prevalence from sites with differing preservation. American Journal of Physical Anthropology, 168(3), 530–542. DOI:10.1002/ajpa.23769

Davies-Barrett, A. M., Roberts, C. A., & Antoine, D. (2021). Time to be nosy: Evaluating the impact of environmental and sociocultural changes on maxillary sinusitis in the Middle Nile Valley (Neolithic to Medieval periods). International Journal of Paleopathology, 34, 182–196. DOI:10.1016/J.IJPP.2021.07.004

Roberts, C. A. (2016). Palaeopathology and its relevance to understanding health and disease today: The impact of the environment on health, past and present. Anthropological Review, 79(1), 1– 16. DOI:10.1515/anre-2016-0001

Shillito, L. M., Namdeo, A., Bapat, A. V., Mackay, H., & Haddow, S. D. (2022). Analysis of fine particulates from fuel burning in a reconstructed building at Çatalhöyük World Heritage Site, Turkey: assessing air pollution in prehistoric settled communities. Environmental Geochemistry and Health, 44(3), 1033–1048. DOI:10.1007/S10653-021-01000-2/FIGURES/9

Zubova, A. v., Ananyeva, N. I., Moiseyev, V. G., Stulov, I. K., Dmitrenko, L. M., Obodovskiy, A. v., Potrakhov, N. N., Kulkov, A. M., & Andreev, E. v. (2020). The use of computed tomography for the study of chronic maxillary sinusitis: Based on Crania from the Pucará De Tilcara Fortress, Argentina. Archaeology, Ethnology and Anthropology of Eurasia, 48(3), 143–153. DOI:10.17746/1563-0110.2020.48.3.143-153