Ph.D. Thesis – H. Battles; McMaster University - Anthropology POLIO MORTALITY PATTERNS IN SOUTHERN ONTARIO (1900-1937) Ph.D. Thesis – H. Battles; McMaster University - Anthropology EXAMINING MORTALITY PATTERNS IN THE EPIDEMIC EMERGENCE OF POLIOMYELITIS IN SOUTHERN ONTARIO, CANADA (1900-1937) By HEATHER T. BATTLES, MA A Thesis Submitted to the School of Graduate Studies for the Degree Doctor of Philosophy McMaster University © Copyright by Heather T. Battles, September 2013 Ph.D. Thesis – H. Battles; McMaster University - Anthropology DOCTOR OF PHILOSOPHY (2013) McMaster University (Anthropology) Hamilton, Ontario TITLE: Examining mortality patterns in the epidemic emergence of poliomyelitis in southern Ontario, Canada (1900-1937) AUTHOR: Heather T. Battles, MA (McMaster University) SUPERVISOR: Professor D. Ann Herring NUMBER OF PAGES: xvi, 218 ii Ph.D. Thesis – H. Battles; McMaster University - Anthropology ABSTRACT This thesis examines patterns in poliomyelitis mortality in Wentworth and York Counties of southern Ontario, Canada, from 1900 to 1937. This period marked polio’s shift from endemic to epidemic status. It was also a time of shifting social, cultural, demographic, and economic patterns. Contemporaries struggled to understand polio’s epidemiology, and even today, with the poliovirus on the verge of global eradication, models to explain its changing patterns and impact continue to be revised. This thesis uses both qualitative and quantitative data collected from a variety of archival sources, including death, birth, and marriage registrations, census records, and newspaper articles, among other records. This information was used to build a geodatabase which forms the basis for analyses of mortality patterns in relation to age and sex, illness duration, seasonality, nativity, birthplace, ethnicity, and religion. Further analyses included family size, birth order, socioeconomic status, and place of residence patterns. Examined in the context of Wentworth and York Counties in the early 20th century, the results both reveal a local pattern to polio’s epidemic emergence and provide a means to test broader hypotheses regarding polio’s epidemiological patterns. Specifically, results from this study were compared to the expectations of the intensive- exposure and cross-sex transmission hypotheses proposed by Nielsen and colleagues. Among the most important contributions of this thesis are the results showing a pattern of change over the study period, with two distinct stages. Stage One (1910 to 1927) is characterized by an equal sex ratio and a median known family size of four. Stage Two (1928 to 1937) is characterized by excess male deaths and a median known family size of two. These results link polio mortality patterns to demographic and ecological shifts in the early 20th century and confirm that there is still much to learn from the history of this disease. iii Ph.D. Thesis – H. Battles; McMaster University - Anthropology ACKNOWLEDGEMENTS First and foremost I want to thank Dr. Ann Herring, who has been the best supervisor I could have asked for. Her extraordinary attention to detail and, at the same time, ability to bring me back to the ‘big picture’, have been invaluable. I am also indebted to my two other committee members, Dr. Tina Moffat and Dr. Michael Mercier, for their always helpful advice and feedback. My thanks also to Dr. Kate Paterson for tipping me off to the wonders of Ancestry.ca, and to Gerald Bierling for his statistical advice. I must also thank the wonderful office staff who not only made sure I hit deadlines and filled out paperwork correctly, but also patiently answered my questions or just let me rant when I needed to. I am grateful to numerous fellow students and colleagues who shared many an office space or café table. A special thanks to Ani Chenier, Stacy Lockerbie, and Becky Gilmour who got me through the writing of the final chapters, and to Dr. Emily Cowall who always makes sure I’m well prepared for any presentation. I have also been fortunate to receive funding for this research from the Social Sciences and Humanities Research Council of Canada, an Ontario Graduate Scholarship, McMaster University’s School of Graduate Studies, and the Department of Anthropology. Last but not least, thank you to my family, including those who saw me begin this project but who have since passed on. When began this research, I thought the poliovirus would be eradicated by the time I completed my dissertation. Polio is still out there, but as I write this India has now passed 30 months without a new case. Though perhaps not as soon as many had hoped, I think we will see a polio-free world in the not-too-distant future. I dedicate this thesis to all those affected by this disease. iv Ph.D. Thesis – H. Battles; McMaster University - Anthropology TABLE OF CONTENTS Chapter 1 Introduction ..................................................................................................... 1 Chapter 2 Background and Theoretical Framework........................................................ 13 Introduction ............................................................................................................... 13 Background ............................................................................................................... 13 Sanitation and health conditions in Wentworth and York Counties ......................... 13 Polio epidemics in Wentworth and York Counties, 1900-1937 ............................... 20 Polio survivors – living with, and dying from, chronic polio .................................. 30 Polio and socioeconomic class – “the middle class plague”? .................................. 31 Socioeconomic class in the early 20th century ......................................................... 32 Socioeconomic class and infant and childhood infectious disease risk .................... 34 Summary ............................................................................................................... 38 Theoretical Framework .............................................................................................. 39 The hygiene hypothesis .......................................................................................... 39 Beyond the hygiene hypothesis: other factors in polio’s epidemic emergence ........ 43 Challenging the polio model: the intensive-exposure model ................................... 45 Summary ............................................................................................................... 47 Chapter 3 Materials and Methods................................................................................... 48 Introduction ............................................................................................................... 48 Materials .................................................................................................................... 48 Primary data sources .............................................................................................. 48 Data quality ........................................................................................................... 50 Methods ..................................................................................................................... 58 Collection of initial sample of polio death registrations .......................................... 58 Outline of initial sample ......................................................................................... 60 Record linkage and construction of database .......................................................... 60 GIS: additional data and analysis ........................................................................... 62 Status score coding ................................................................................................ 64 Statistical analysis .................................................................................................. 65 Summary ............................................................................................................... 66 Chapter 4 Results and Discussion: Patterns of Polio Mortality and Demography............ 68 Introduction ............................................................................................................... 68 v Ph.D. Thesis – H. Battles; McMaster University - Anthropology Age and Sex............................................................................................................... 68 Age at death ........................................................................................................... 68 Sex: males vs. females ........................................................................................... 76 Age and sex ........................................................................................................... 77 Main findings and discussion ................................................................................. 78 Illness Duration and Seasonality ................................................................................ 83 Chronic polio ......................................................................................................... 83 Acute illness duration............................................................................................. 84 “Death Walks in Summer”: seasonality of polio mortality ...................................... 87 Main findings and discussion ................................................................................