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

Objectives - The aim of this study was to assess the tuberculosis-related m ortality rate in four major French cities (Paris, Lyons, Marseilles, Montpe llier) between 1751 and 1939. Material and method - Data were collected from weekly and monthly statistic s published in magazines and books. Results - Results show that there was an inversion in the distribution of m ortality according to sex (a higher female mortality in the past, and a hig her 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 o f the mortality peak towards older age groups. At the end of the 19th centu ry, the mortality rate decreased in all four cities. In Paris, mortality st arted falling sharply in 1927, while in Lyons this came about only after 19 34, even though BCG, introduced in 1924, was used everywhere in France from 1927 on. The influence of socioeconomic factors on mortality due to tuberc ulosis 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 no t the only reason for the decrease in disease since this was already observ ed at the end of the 19th century. (C) 2000 Editions scientifiques et medic ales Elsevier SAS.