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 (Omran, 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 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 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.
Highlights
An Overview of TuberculosisTuberculosis is an ancient disease and has been one of the biggest causes of death among societies throughout history (Kaufmann & Britton, 2008)
Our results suggest that in Switzerland, the second transition occurred before the implementation of major medical advances, such as chemical therapy/antibiotics and in the case of tuberculosis, before use of Bacille Calmette Guerin (BCG) vaccine
The results presented here suggest that tuberculosis mortality rates declined more rapidly in high population density cantons than in low-density cantons, which may be due to progressive improvements in sanitation and changing strategies for handling tuberculosis patients which may be more effective in more crowded areas
Summary
Tuberculosis is an ancient disease and has been one of the biggest causes of death among societies throughout history (Kaufmann & Britton, 2008). Tuberculosis occurs in individuals infected with a bacterium called Mycobacterium tuberculosis and who cannot control the organism effectively due to a lowered immunity (North & Jung, 2004). Mycobacterium tuberculosis does not always cause disease; only approximately 10% of infected individuals suffer pathological signs and symptoms (Wilbur et al, 2008). Since M. tuberculosis spreads mostly through the respiratory tract, the common pathological signs and symptoms include coughing, difficulty breathing, bloody sputum, weakness, lethargy, loss of appetite and weight, night sweats, pallor and chest pain (Dormandy, 1999; Wilbur et al, 2009). Tuberculosis can affect any part of the body and with time, the bacteria can disseminate from soft tissues of the lungs to the other parts of the body, including the bones (Wilbur et al, 2008)
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