Tuberculosis Mortality among the Jews of Tunis (Tunisia) in the First Half of the Twentieth Century
Cattan, Daniel, Mallet, Alain, Feingold, Josué, Population
A long series of studies conducted some years ago has shown or pointed to a lower incidence of tuberculosis mortality among Jewish populations than other populations living in the same regions (Arnould, 1934; Calmette, 1928; Fishberg, 1908; Rakower, 1953; Sawchuk and Herring, 1984), and particularly so in the city of Tunis (Bloch, 1951; Cattan, 1914; Hayat, 1935; Sebag, 1959; Scialom, 1921; Toistivint and Remlinger, 1900; Valensi and Conseil, 1913).
In this short paper we will look at tuberculosis mortality among the Jewish population in the city of Tunis as reflected in cause of death tables, and compare it with that of other populations. Our study bears out the findings of lower mortality, and in the discussion section we will examine the possible reasons for this phenomenon.
I. Material and method
Five-yearly population censuses were carried out under the French Protectorate (1881-1955), except during the two World Wars. These give a count of the communities (French, Muslim, Jewish, Italian, Maltese) living in the city of Tunis (Table 1). Also, from 1885 onwards, a medical certificate of death stating the community and principal cause of death was required before burial could take place(1).
The "Statistiques démographiques et médicales, Régence de Tunis, Protectorat français" (Population and health statistics, Regency of Tunis, French Protectorate) published by the Bureau d'hygiène (Board of Health) of the city of Tunis available in Tunis city library, and the "Annuaire de la Tunisie" (Tunisia yearbook) readily consultable at INSEE (French National Institute for Statistics and Economic Research), provide community- and sex-specific cause of death figures for each year from 1909 to 1955, with gaps during the World Wars. Since 1946, furthermore, the statistics have been available by age at death (though not by community and by age). A 1935 thesis (Rekik, 1935) provides valuable data on infant mortality data for 1927-1934.
A population pyramid is available for 1946 only. Annual recorded deaths by community and cause are available for 1919 to 1939 (excluding 1933) for the French, Muslim, Jewish, Italian and Maltese populations. The statistics break off at this point and resume in 1944, first for the period 1944-1946 (grouped data) then annually up to 1956. Since 1944, however, the French, Italian and Maltese communities have been aggregated in the single "European" category.
From 1919 to 1956, the infectious or parasitic diseases counted as causes of death were: typhoid fever, tuberculosis, exanthematic typhus, malaria, smallpox, influenza, cholera-like infections, diphtheria, measles, and scarlet fever.
The socioeconomic data for the same period are drawn from accounts by travellers, doctors and the work of historians (Sebag, 1959; Sebag, 1991; Sebag, 1998).
The infant mortality rate (IMR), i.e. the ratio of the number of children who died before their first birthday to all live births in a year, is a good socioeconomic indicator (Reidpath and Allotey, 2003). It is available for the French, Muslim, Jewish, Italian and Maltese communities from 1919 to 1934, and for Europeans (French, Italian and Maltese combined), Muslims and Jews from 1940 to 1955.
For tuberculosis, finally, which was not a notifiable disease, partial data on morbidity among the civilian population are available, published by the tuberculosis dispensaries.
2. The communities
The origins of the different communities living in Tunis can be determined from various studies (Levy, 1999; Loth, 1905; Roth, 2002; Sebag, 1991; Sebag, 1998).
In the Muslim community, long coexistence, multiple contacts and exchanges, and inter-group unions contracted in previous centuries meant that by the early twentieth century, it was no longer possible to distinguish between Moors, Turks, Mamelukes, Berbers, Andalusians and Black Africans, especially those from Niger. …