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Secular Trends in Tuberculosis During the Second Epidemiological Transition: a Swiss Perspective

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Secular Trends in Tuberculosis During the Second Epidemiological Transition: a Swiss Perspective Zurich Open Repository and Archive University of Zurich Main Library Strickhofstrasse 39 CH-8057 Zurich www.zora.uzh.ch Year: 2013 Secular trends in tuberculosis during the second epidemiological transition: a Swiss perspective Holloway, Kara L ; Henneberg, Renata ; de Barros Lopes, Miguel ; Staub, Kaspar ; Link, Karl ; Rühli, Frank J ; Henneberg, Maciej Abstract: The second epidemiologic transition is defined as “the age of receding pandemics”, wherein mortality declines, life expectancy increases, and population growth occurs. The major causes of death also shifted from predominantly acute infectious diseases to degenerative and “man-made” diseases (Om- ran, 1983). The aim of this study was to determine the timing of the transition in Zürich (Switzerland) and to investigate patterns of tuberculosis mortality during this period. This is one of the first studies to specifically investigate the timing of the second transition in Zürich, Switzerland. The data sourcesfor this study were Swiss records of mortality from the Staatsarchiv (Canton Archives), Stadtarchiv (City Archives) and a published volume of State Statistics (Historische Statistik der Schweiz). The changes in mortality through time were addressed for all causes of death in the city ofZürichfor the years 1893 to 1933 that is, the time including the second epidemiological transition. After 1933 the structure of the mortality data collection changed as the responsibility was transferred away from the canton archives. Mortality from tuberculosis was then examined in greater detail and compared with changes in living standards as well as population density occurring at the time. DOI: https://doi.org/10.4236/aa.2013.32011 Posted at the Zurich Open Repository and Archive, University of Zurich ZORA URL: https://doi.org/10.5167/uzh-78615 Journal Article Published Version Originally published at: Holloway, Kara L; Henneberg, Renata; de Barros Lopes, Miguel; Staub, Kaspar; Link, Karl; Rühli, Frank J; Henneberg, Maciej (2013). Secular trends in tuberculosis during the second epidemiological transition: a Swiss perspective. Advances in Anthropology, 03(02):78-90. DOI: https://doi.org/10.4236/aa.2013.32011 Advances in Anthropology 2013. Vol.3, No.2, 78-90 Published Online May 2013 in SciRes (http://www.scirp.org/journal/aa) DOI:10.4236/aa.2013.32011 Secular Trends in Tuberculosis during the Second Epidemiological Transition: A Swiss Perspective Kara L. Holloway1, Renata Henneberg1, Miguel de Barros Lopes2, Kaspar Staub3, Karl Link3, Frank Rühli3, Maciej Henneberg1 1Biological Anthropology and Comparative Anatomy Research Unit, University of Adelaide, Adelaide, Australia 2Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia 3Centre for Evolutionary Medicine, Institute of Anatomy, University of Zürich, Zürich, Switzerland Email: [email protected] Received January 17th, 2013; revised February 23rd, 2013; accepted March 1st, 2013 Copyright © 2013 Kara L. Holloway et al. This is an open access article distributed under the Creative Com- mons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, pro- vided the original work is properly cited. The second epidemiologic transition is defined as “the age of receding pandemics”, wherein mortality de- clines, life expectancy increases, and population growth occurs. The major causes of death also shifted from predominantly acute infectious diseases to degenerative and “man-made” diseases (Omran, 1983). The aim of this study was to determine the timing of the transition in Zürich (Switzerland) and to investi- gate patterns of tuberculosis mortality during this period. This is one of the first studies to specifically in- vestigate the timing of the second transition in Zürich, Switzerland. The data sources for this study were Swiss records of mortality from the Staatsarchiv (Canton Archives), Stadtarchiv (City Archives) and a published volume of State Statistics (Historische Statistik der Schweiz). The changes in mortality through time were addressed for all causes of death in the city of Zürich for the years 1893 to 1933 that is, the time including the second epidemiological transition. After 1933 the structure of the mortality data collec- tion changed as the responsibility was transferred away from the canton archives. Mortality from tuber- culosis was then examined in greater detail and compared with changes in living standards as well as population density occurring at the time. Keywords: Tuberculosis; Second Epidemiological Transition; Switzerland Introduction and chest pain (Dormandy, 1999; Wilbur et al., 2009). Tuber- culosis can affect any part of the body and with time, the bacte- An Overview of Tuberculosis ria can disseminate from soft tissues of the lungs to the other Tuberculosis is an ancient disease and has been one of the parts of the body, including the bones (Wilbur et al., 2008). biggest causes of death among societies throughout history In Europe, tuberculosis was likely responsible for 20% to (Kaufmann & Britton, 2008). Tuberculosis occurs in individu- 25% of all deaths during the 1500s (Stead, 2001). There are als infected with a bacterium called Mycobacterium tuberculo- difficulties with this estimate, however, because relevant his- sis and who cannot control the organism effectively due to a torical records can be absent, or incomplete and ambiguous on lowered immunity (North & Jung, 2004). Tuberculosis is usu- cause of death in the pre-modern era. For example, in many ally transmitted by inhalation of aerosols generated primarily countries, physicians were hesitant to diagnose tuberculosis by coughing (Cole, Eisenach, McMurray, & Jacobs Jr., 2005). because of the social implications for the patient and instead However, ingestion of contaminated meat and dairy products is recorded the cause of death as some other unspecified pulmo- a route of infection for the related bacterium, Mycobacterium nary disease (Johnston, 1995). The term “tuberculosis” also did bovis, which predominantly infects cattle but can cause infection not become widely used until the 1830s (Wilbur et al., 2008). A in humans (Waddington, 2004; Wilbur, Farnbach, Knudson, & number of other names were given to pulmonary conditions Buikstra, 2008). presenting tuberculosis-like signs and symptoms including Mycobacterium tuberculosis does not always cause disease; “consumption”, “phthisis” and “the white plague”, while dis- in fact only approximately 10% of infected individuals suffer eases of other organs caused by M. tuberculosis were referred pathological signs and symptoms (Wilbur et al., 2008). A pa- to as tabes mesenterica and “scrofula” or “King’s evil” (Herzog, tient can even be asymptomatic and thus appear to be “cured” 1998; Miller & Thompson, 1992; S. Newsom, 2006; Smith, for long periods of time, yet may show signs and symptoms 1988). In addition, disease diagnosis prior to the 19th century later in life. Since M. tuberculosis spreads mostly through the did not have a high degree of certainty, and new systems of respiratory tract, the common pathological signs and symptoms disease classification were introduced in the early 20th century include coughing, difficulty breathing, bloody sputum, weak- (Dormandy, 1999; Rucker & Kearny, 1913). Improving accu- ness, lethargy, loss of appetite and weight, night sweats, pallor racy in diagnostics and shifts in disease classification can cause 78 Copyright © 2013 SciRes. K. L. HOLLOWAY ET AL. problems in interpretation of the mortality and morbidity of among the populace, especially the loss of traditional rights of tuberculosis through time as disease categories associated with the individual cantons, Napoleon altered the Helvetic Republic tuberculosis can also include several other conditions. For ex- with “The Act of Remediation” in 1803, which did not return ample, “phthisis” may also include other pulmonary diseases the cantons to Swiss control but did reintroduce some tradi- with symptoms similar to pulmonary tuberculosis. However, tional rights. Napoleon lost control of Switzerland in 1814 and the disease now known as tuberculosis has been reported in in 1815 a Federal Treaty was signed. This reverted the country some ancient literature such as a Babylonian text written by the to pre-Napoleonic policies and provided regulations for politi- monarch Hammurabi between 1948 and 1905 BCE (Herzog, cal relationships between the cantons (Bouvier et al., 1994; 1998; Kaufmann & Britton, 2008; S. Newsom, 2006; Steinberg, Remak, 1993; Steinberg, 1996). France was also required to 1996). We investigated patterns in tuberculosis during the 19th pay compensation for damages incurred during Napoleon’s and 20th centuries, many years after it was first described in military campaigns, which supported Switzerland’s economic these ancient writings. Thus, while some diagnoses are likely to development. The Treaty also introduced the concept of neu- be incorrect, the majority will not be. We considered the terms trality. While the Swiss citizenry was supportive of this, they “tuberculosis”, “consumption”, “phthisis”, “scrofula” and “King’s did not support the Treaty’s centralization of the country (Re- Evil” as evidence of tuberculosis since these were the most mak, 1993). commonly used terms during the time period under investiga- In 1831, the 1815 Treaty was effectively rejected (Steinberg, tion (Burke, 2011). 1996). Religious schisms also arose, driven in part by issues of economic inequality: more urban, prosperous cantons
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