Was the rise of TB contemporaneous with the industrial revolution? Epidemiological evolution of TB in France (17th-20th centuries) inferred from osteoarchaeological and historical archives

Abstract

Objective: The development of tuberculosis is classically associated with the rise of the Industrial Revolution. Our objective is to test this epidemiological hypothesis for populations in France between the 18th and 20th centuries using osteoarchaeological and historical sources.

Materials: Osteoarchaeological sources include two skeletal collections from plague epidemics in Provence (1590 and 1722) representing a total of 349 individuals and medical archives dating 1750-1930 from Paris, Lyon, Marseille, Montpellier.

Methods: Paleoepidemiological analysis (crude prevalence rate) of the archeological data, and epidemiological analysis of historical data included the proportional mortality rate of tuberculosis (PMR-TB) and the mortality rate by tuberculosis (MR-TB).

Results: Mean prevalence of TB before the 19th century was approximately 30 %, according to osteoarchaeological data. Historical sources showed that pulmonary TB was responsible for 33 % of total deaths in the city of Marseille during the second half of the 18th century and represented about 20 % of deaths in the four French cities during the 19th century. The mortality rate was 6.5 per thousand inhabitants in the 18th century (Marseille) and stable at 4-5 ‰ during the 19th century before, during, and after the Industrial Revolution period, with the exception of years 1870-1871 (French-Prussian war), when it increased.

Conclusions: Population increase contemporary to the industrialization process did not increase the mortality rate by tuberculosis in France.

Significance: The epidemiological assertion that tuberculosis increased with the Industrial Revolution in cities must be reevaluated. In France, and perhaps in other cities, it was an endemic disease at least a century before, and associated with a higher mortality rate.

Limitations: Reliability and biases inherent to archaeological and historical data prior and during the Industrial Revolution must be taken into account.

Suggestions for further research: Extension of research to all the French territories (rural and urban areas) is advised.

Keywords: Cities; Lyon; Marseille; Montpellier; Paleoepidemiology; Paris.