It is well-known that urban mortality was higher than rural mortality until well into
the twentieth century. Ever since Malthus characterised the phenomenon now known as the
“urban graveyard effect”, the study of urban mortality has attracted the
interest of many scholars. This terrible image of the cities was
nourished, to a large extent, by two of their principal features: acting as a pole of attraction for the working
age population and their role as administrative centres. The first occasioned a continuous
inflow of the rural population fleeing from the country, where the same employment
opportunities did not exist as were to be found in the cities. Migration increased
population density in the city environment, already in and of itself higher than in the
countryside, promoting the diffusion of diseases in cities that were usually
dirty,
unhealthy and with poor housing conditions, often constructed near swampy
areas. As
administrative centres, the cities had to sustain, aside from other institutions,
hospitals, prisons, retirement homes and foundling hospitals, with their pernicious
effects on mortality. The impact on urban mortality was accentuated because sections of
the institutional population were not usually resident in the cities but in the contiguous
rural areas. Moreover, the cities also served as religious and military administrative
centres, bringing further inhabitants to the cities.
On the other hand, fertility and nuptiality were lower in the cities, resulting in
lower natural urban growth rates than in the rural areas. Growth rates were usually
negative. Nevertheless, the cities still grew in population. This
phenomenon, known as
“natural decrease problem”, has inclined some authors to assert that the
“city populations were only sustained due to migration”. The controversy between
the advocates of the “urban natural decrease” model and the advocates of the
“urban migration” model has transformed the study of the conditions of urban
life which now incorporates the analysis of mortality, taking into account the extent and
direction of migration.
An important unresolved issue is whether living conditions in the cities were really
that bad and whether due allowance in the measurement of mortality has been accorded the
fact that the cities were the administrative centres and poles of attraction for migrants.
When Sharlin established his “urban migration” model he considered that the
arrival of migrants in the cities changed the balance between births and
deaths, since the
migrants, according to his theory, inflated the number of deaths, while contributing far
less to the number of births than the permanent residents. In terms of
mortality, the
obvious impact would be an increase in the number of deaths of persons of working age.
But in fact, migration could also affect the number of deaths in other age groups. For
example, little attention has been given to the influence on the level of urban mortality
of the geographical distribution of health and welfare agencies. By the middle of the
nineteenth century, in countries such as Spain, most of the health institutions were
located in the principal cities, and not until much later were such facilities expanded to
smaller cities or towns. The rural population residing in the vicinity of the city and
demanding health care needed to travel to the city's health institutions to receive
attention. A proportion of those temporary migrants died in the city increasing the number
of deaths. These deaths, in the Spanish case, were normally not registered in the person's
place of origin but instead were registered in their place of death. Both English and
Spanish data indicate the scale of the problem. In seven London hospitals during the last
third of the nineteenth century, 12 per cent of deaths were of persons normally resident
outside the city. In an earlier period (1774-81) almost 75 per cent of all patients at
Westminster General Dispensary in London were born outside London. In Toledo,
Spain, by
1877, 53 per cent of all deaths in the city were of people who had been born outside its
walls. This proportion was higher among those dying in hospitals (63 per cent) and much
higher among those dying in foundling hospitals (84 per cent). The effect that foundling
hospitals had on overall urban mortality levels has also received little attention. Such
institutions were usually located in provincial capitals, and collected abandoned children
from the entire province. Although it is true that in some cases the orphans in foundling
hospitals were sent to rural areas to be raised, the majority of them died during their
first days or weeks in the orphanages, before they could be sent to the
countryside. The
high probabilities of dying in this type of institution, characterised by Stone as
“highly effective infanticide agencies”, certainly inflated the level of
childhood mortality in the cities. Although there can be no doubt that the levels of urban
mortality would still exceed those in the rural areas even after all the correction
factors have been taken into consideration, there can equally be no doubt that the
application of the correction factors could greatly reduce the difference between
mortality rates in rural and urban areas.
A number of recent studies have considered the effect of migration and mortality in
institutions on urban mortality but many important questions affecting our understanding
of the impact of urbanisation remain unanswered. For example it is still unclear to what
extent the presence of heath facilities in the cities influenced urban mortality either
directly (higher mortality in such institutions than in the general population) or
indirectly (acting as poles of attraction for migrants from outside the
cities). Was urban
mortality so high partly as a result of the influence of an administrative effect whereby
deaths were recorded in the place of occurrence and not in the place of origin of the
person? The migration of a very small proportion of population from the countryside to the
city, some to live and work, others just to use their health facilities, and the
unfortunate among them to die inside them could have had major impact on urban
mortality.
When account is taken of these influences, was the mortality of those inhabitants who had
been born in the city so bad? Is it the case that cities grew because of migration even
though this migration increased levels of urban mortality? Furthermore, one of the most
important changes affecting urban mortality in Spain and in most European Countries
occurred during the 1920s, when the level of infant mortality of urban areas first fell
below the level of the infant mortality rate in rural areas. This crucial period on
European urban history has received little attention and it has being neglected the
analysis of the causes driving to that radical change. The use of a database derived from
the Vital Statistics of Spain for 1904 - 1907, 1914- 1917, 1924 - 1927 and 1931 - 1933
that combines information on mortality by age, sex and cause of death at provincial and
provincial capitals levels can enable me to construct life tables for different years
during the first quarter of the twentieth century and also can enable me to answer the
questions raised in this paper. Interpretation of the results is assisted by the fact that
between 1910 and 1930 there was no change in Spain in the way diseases were classified by
cause of death because Spain chose not to implement the 1920 revision of the International
Classification of Diseases