Tuberculosis mortality in France from the 18th to the 20th century

Objectives - The aim of this study was to assess the tuberculosis-related mortality rate in four major French cities (Paris, Lyons, Marseilles, Montpellier) between 1751 and 1939. Material and method - Data were collected from weekly and monthly statistics published in magazines and books. Results - Results show that there was an inversion in the distribution of mortality according to sex (a higher female mortality in the past, and a higher male mortality today) around the middle of the 19th century. As for the age distribution of mortality two trends were determined; on the one hand, the decrease of infanto-juvenile mortality; on the other hand, the shift of the mortality peak towards older age groups. At the end of the 19th century, the mortality rate decreased in all four cities. In Paris, mortality started falling sharply in 1927, while in Lyons this came about only after 1934, even though BCG, introduced in 1924, was used everywhere in France from 1927 on. The influence of socioeconomic factors on mortality due to tuberculosis was demonstrated clearly in Paris, where the disease did not spread the same way around the city. Comments - This analysis of historical data showed that tuberculosis was an epidemic disease in France before the 19th century. BCG vaccination was not the only reason for the decrease in disease since this was already observed at the end of the 19th century. (C) 2000 Editions scientifiques et medicales Elsevier SAS.