Urban French mortality in the nineteenth century

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Abstract
Following population reconstructions, age-specific death rates and life tables are computed for five-year periods during 1816-1905 for the three largest urban départements of France. During the early decades of the period, life expectancy at birth in the urban départements is about five to ten years lower than that of France as a whole. At some point after the mid-century, the gap in each of the three is reduced. However, the timing of accelerated mortality reduction varies considerably and appears to be related to the timing of improvements in water supply and sewerage. This inference is supported by cross-sectional and time series records on causes of death. In Bouches-du-Rhône, where water-support systems were not modernised until the 1890s, life expectancy in 1871-90 was only 1-5 years higher than in 1816-45; and water- and food-borne diseases account for a major amount of its disadvantage relative to the other départements. A striking tendency is revealed for mortality gains after mid-century to proceed in a cohort-specific fashion. The hypothesis is put forward that water and sewerage improvements, by reducing the burden of intestinal (and probably respiratory) diseases among young children, resulted in improved physical growth and development. These improvements, in turn, led to mortality reductions at later ages. Nutritional advances cannot be ruled out as important contributors to the revealed patterns. However, the independent role of the early disease environment seems to deserve greater emphasis than it has often received.