Evidence of infectious disease, trauma, disability and deficiency in skeletons from the 19th/20th century correctional facility and asylum «Realta» in Cazis, Switzerland.

As a reaction to widespread poverty, a system of coercive welfare developed in Switzerland during the 19th century. Poverty was often thought to result from an individual's misconduct rather than from structural, economic or political circumstances. People whose lifestyle deviated from the desired norm or who were unable to make a living for themselves were subjected to so-called administrative detention at institutions such as workhouses and poorhouses. The excavation of the cemetery of the correctional facility/workhouse and asylum «Realta» in Cazis offered the opportunity to gain insight into the living conditions of a marginalized group of people and to shed light on aspects of coercive welfare that have hardly been addressed in historical studies. A comprehensive study of pathological alterations was used to assess possible physical causes and effects of administrative detention. Skeletal samples from regular contemporaneous cemeteries provided data for the general population and thus allowed us to detect peculiarities in the «Realta» assemblage. Possible cases of Stickler Syndrome, microcephaly, congenital syphilis, endemic hypothyroidism and disabilities secondary to trauma may have been the reason for the affected individuals' institutionalisation. The high prevalence of tuberculosis was linked to the socioeconomic status and the living conditions at the facility. Several cases of scurvy and osteomalacia may have resulted from various risk factors such as poverty, alcoholism, mental illness or institutionalisation. The fracture rates, especially of ribs, were extremely high. A large proportion of the fractures were incompletely healed and most likely occurred during detention due to interpersonal violence. Underlying diseases further contributed to the high fracture rates. This first study on skeletons from an institution of administrative detention in Switzerland demonstrated how pre-existing health conditions and the socioeconomic background contributed to the chance of being detained, and how detention led to further deterioration of health.