Economic History Society Annual Conference
Robinson College, University of Cambridge, 1-3 April 2011
Is industrialization alone to blame for damaging their life prospects?
Determinants of infant mortality variations across France in the 19th C
Jean-Pascal Bassino1 and Jean-Pierre Dormois2
French demographic history in the 19th Century is notorious for its precocious diffusion of
birth control and was once summed up by an Oxford demographer as “copulation without
population.” Voluntary restraint on procreation resulted in a slower growth of the total
population and an age structure at odds with other European societies in which younger
generations were less numerous than elsewhere.1 It is also believed to have helped maintain a
standard of living in line with more demographically and economically dynamic neighbours.2
With a slower aggregate economic growth over the period 1820-1914, French GNP per capita
kept apace at 1.6% per annum, not far behind the British rate. Some observers have tended to
believe, therefore, and historians have been inclined to follow in their steps, that the
gradualism of French economic development in this period had been beneficial to the living
conditions of the mass of the population.
This flattering interpretation does not fit well with existing information on the biological
wellbeing such as the average height of young men or infant mortality (IM) that should
exhibit an upward trend as material conditions improve. Official average infant mortality
remained stuck above 170 per 1000 between the 1850s and the 1900s, even deteriorating in
the middle decades, and a parallel stagnation of average height of French conscripts can be
observed (at around 165.5 centimetres) between the 1820s and the 1880s (years of birth).
Furthermore, upon closer inspection, it is likely that official records underestimate actual
infant mortality; the true figures were probably closer to 200 per 1000, on a par with the worst
rates observed in present day sub-Saharan regions. At 300 per 1000, a number of French
regions were plagued by infant mortality rates comparable to that of Southeast Asian regions
1
University of Montpellier III Paul Valery: jpbassino@gmail.com
University of Strasbourg: dormois@umb.u-strasbg.fr
1
In 1851 35% of the French population were aged 20 or below compared with 44% in England (Ariés, 1980,
p. 350).
2
Clough, 1946, p. 100.
2
1
affected by a high prevalence of tropical diseases (e.g. Philippines Commission 1905).
However, infant mortality was affected by a variance of large magnitude across French
regions and could fall in some departments below the 120 per 1000 mark.
The determinants of the regional variance in height have been extensively investigated. In
particular, income per capita, education, and milk availability had a significant and positive
influence in 19th Century France (Weir 1997, Baten 1999). By contrast, the determinants of
infant mortality have been little studied and not clearly identified, and this remark applies to
the determinants of mortality in general (Cutler, Deaton, and Lleras-Muney 2006). The
purpose of this paper is to investigate the sources of the observed variance, and to assess the
extent to which industrialisation was responsible for the persistence of high infant mortality,
using a battery of indicators at the departmental level on the level of industrial employment,
living standards, direct and indirect, and consumption levels, female education, the presence
of obstetric services. A negative correlation is typically observed between IM and various
indicators of biological well-being, either as time trend or in cross-section at the country level.
In this perspective, 19th century French departments present a patchwork of different
situations: for instance, a number of poor French rural regions were characterized by
comparatively low infant mortality while lagging behind in terms of welfare, as measured by
average height of conscripts. This mismatch in regional rankings should not be surprising.
Infant mortality could (and can) fluctuate widely while changes in height, for instance, are
constrained by biological mechanisms (Cole 2003). Exogenous infant mortality could
increase sharply in certain regions following negative asymmetric shocks, while it could drop
rapidly in other regions as a result of an increase in health spending, or the introduction of
new technology. Some indicators (such as height) which registered a high level of variance
could reflect differences in initial conditions, i.e. before industrialisation.
Since infant mortality reflects the combined positive and negative influences of various
socioeconomic and environmental conditions, an investigation of its determinant should be
based on an extensive data set. We process information not only on average height of
conscripts, the share of the female labour force working in factories, various measures of
income and nutrition, primary education and the supply of health services, from the mid-19th
century onwards at the department level (86 to 89 territorial units, depending of the period).
We also use the panel set for evaluating the incidence of infant mortality, used indicator of
non-lethal exposure to transmissible diseases affecting the growth in stature during childhood
and adolescence, on average adult height. First we survey the main features of infant mortality
at the national department level and in the European context. We then review the possible
2
connection between infant mortality and the various factors associated with the development
of industrialisation and assess their quality and characteristics of the panel data.
1. The protracted escape from (very) premature death
1.1 French quality of life in the 19th Century in comparative perspective
French politicians of the Third Republic (such as Jules Méline3) made extensive use of the
argument that limited or controlled industrialisation had spared the country of the ‘worst
excesses of the industrial revolution’. Such a conviction has permeated historical assessments
of French economic development in the 19th Century and the conviction that limited rural
migrations and urbanisation, slower industrial growth, the persistence of family workshops
and artisanal traditions created a more ‘gentle’ form of industrialisation which limited the
apparent deterioration of living conditions observable in more dynamic industrial areas in
neighbouring countries.
Table 1. Indicators of ‘quality of life’ in France in the 19th Century
1820
1850
1870
1880
1890
1900
GDP
per capita
(1990 US $)
[1]
1218
1669
1858
2100
2354
2849
Height
of conscripts
Cm
[2]
164.3
164.7
165.4
165.5
166.1
167.0
life expectancy
at birth
years
[3]
33
42
--46.8
--
IMR
‰
[4]
176
145
157
155
141
132
literacy (male
conscripts)
%
[5]
na
64.0
82.1
84.4
93.6
95.8
Sources: [1] Maddison 2001; [2] Weir 1997; [3] Fogel 2004; [4] Bourgeois-Pichat 1951/1965; [5] Statistique de
l’enseignement primaire.
Upon cursory inspection of ‘quality of life’ indicators, however, France doesn’t seem to
have enjoyed a particularly privileged position. At the $1,800 level reached by Britain around
1800 (and in France 60 years later) French young men were on average shorter but started in
life with a superior life expectancy; also, as underlined by Crafts, France entered
industrialisation at a relatively high level literacy. With regard to mortality it doesn’t seem
that sanitary conditions were more satisfactory across the Channel, however; infant mortality
3
See his bestseller The Return to the Land (1905, English edition 1907).
3
in particular showed no sign of abating in England as in France before the turn of the 20th
Century. Fogel’s statement: “It is now clear… that the [industrial revolution] brought only
modest and uneven improvements in the health, nutritional status and longevity of the lower
classes before 1890” seems particularly appropriate in the French in the English cases (Fogel,
2004, p. 8). Furthermore, contrary to the experience of most industrializing countries where
the fall of mortality stabilized during the first phase of industrialization, in the French case the
curve evidences a ‘bulge’ in the period following the first spurt of industrialization between
1850 and 1880. This corresponds to the time of the Second Empire (1851-70) which
witnessed the dramatic expansion of modern industry and its trail of misery brought to public
attention by the novels, among others of Émile Zola (1840-1902) published between 1871 and
1893, especially L’Assommoir and Germinal. Despite the improvement in living standards
during the Great Depression, IM shows no sign of improvement before the turn of the 20 th
Century. The parallel with the situation in England appears striking.
Figure 1. Nation-wide infant mortality in the 19th Century, France, Ireland and England
350
300
infant mortality rate (‰)
250
FRANCE (adjusted)
200
FRANCE (crude)
150
ENGLAND & WALES
IRELAND
100
50
0
1830
1840
1850
1860
1870
1880
1890
1900
1910
There is reason to believe, however, that the official count of children’s deaths under one
year of age may be underestimated. For most of 19th Century the ratio of still-births to IM (or
4
the birth rate) at the department level appears unrealistic, and totally out of line with available
information at the city level for the end of the century (which is better documented). Typical
ratios of stillbirths to the total number of births were 0.15% in most cities but aggregates by
department exhibit much higher ratios suggesting that the category includes a number of
babies who died in the first days of their life and should therefore be included in the IMR.
From 1871, the heading of this category specifies: “Stillbirths and deaths which occurred
before birth registration.” As a consequence we have computed, besides the “lowerbound,” an
“upperbound” IMR which includes the “unnatural” portion of “stillbirths;” as will be seen it
affected the ranking of some departments, the favourable position of which couldn’t be
accounted for in the absence of this adjustment.
1.2 The persistence of high IM during the first phase of industrialisation
After the fall of mortality between 1725 and 1825, often associated with the elimination of
severe harvest failures, overall mortality and infant mortality tended to stabilize at a relatively
high level for the rest of the 19th Century. Until 1890 France sat on the line break between
North Western Europe with relatively low IM and the more backward Southern and Eastern
portion of the Continent (Figure 2).
Compared to England and Wales the French national average was pitched much higher and
it comes as something as a surprise: why wasn’t IM in a still predominantly rural country with
only a few industrial centres not closer to the level of Ireland rather than being aligned on the
‘English’ pattern (only it was worse)? Could it be that the persistence of high IM in France in
the 19th century was the result of a conjunction of the persistence of unhealthy conditions and
lethal practices in the country with industrialisation-induced disamenities in the cities?
The connection between high infant mortality and the influence of the material
environment was clearly identified by contemporary observers. Indeed there was an already
influential hygienist school of thought, which deplored city-life as intrinsically unhealthy and
corrupt (and rural communities as having been contaminated by urban habits). Besides, the
development of industries in urban settings was perceived as aggravating the poor living
conditions in working class neighbourhoods.
From 1871 the registration of causes of death by age groups became systematic and was
reported annually. IM appears to have been much higher in larger cities than in smaller towns
suggesting a causal relationship between city size and sanitary conditions. It was soon
assigned to the damaging effects of and unhealthy environment provided by large industrial
5
concentrations. Late 19th Century detailed information confirms this diagnosis: urban IM
exceeded by far the national average (around 180‰) and large provincial cities, especially
those with a population above 100,000 inhabitants presented the worst environment for babies
(Figure 3).
Figure 2. France’s infant mortality in comparison with other European countries, c1890.
300
Infant mortality rate (‰)
250
200
150
100
50
N
Ire
la
n
or d
w
Sw ay
e
Sc den
ot
l
D and
en
m
a
Fi rk
nl
a
Bu nd
lg
ar
i
Se a
r
E bi
Sw ng a
itz lan
er d
la
Be nd
N
et lgiu
he m
rla
nd
Fr s
an
ce
Sp
ai
n
Ita
R
om ly
G ani
er a
m
a
Au ny
s
H tria
un
ga
r
R y
us
si
a
0
Source: Mitchell, European Historical Statistics
On the basis of the late century survey on sanitary conditions in French towns, used here as
a guide to investigating the causes for persisting high IM, two physicians, Balestre and
Gilletta believed ‘normal’ (later labelled ‘endogenous’) IM to have been of the order of 80‰
and identified the propagation of external infectious diseases in urban centres as accounting
for at least 60% of prevailing infant mortality rates; furthermore, they asserted that this
transmission could be directly traced to prevailing material conditions and was therefore in a
large measure avoidable. Recent statistical investigation has confirmed this conjecture and
pushed the proportion of ‘exogenous’ IM as high as three quarters of the total, observed IM in
the second half of the 19th Century (Figure 4).
6
Figure 3. IM in relation to city size, 1887-1895
400
380
360
340
Infant mortality rate (‰)
Cities w/ pop >100,000
320
Paris
300
280
Cities
10-30,000
Cities 30-100,000
260
240
Cities 10-20,000
220
Towns w/ pop 5-10,000
200
1887
1888
1889
1890
1891
1892
1893
1894
1895
Source: Statistique sanitaire des villes de France (1895).
Figure 4. The exogenous component of infant mortality, France 1850-1913
250
endogenous
exogenous
Infant mortality rate (‰)
200
150
100
50
0
1855 1859 1863 1867 1871 1875 1879 1883 1887 1891 1895 1899 1903 1907 1911
Source: Nadot 1970.
7
Balestre and Gilletta (1901) used these sources to investigate the causes of infant mortality
in relation to city size and focused on the upper segments of the database compiled in official
statistics: Paris and the groups of cities with less and more than 100,000 and 30,000
inhabitants (numbering 11 and 47 respectively). They came up with the following table:
Table 2. Cause of death among infants, 1892-7 (%)
Paris
Diarrhoea, gastroenteritis
Respiratory ailments
Tuberculosis
Other infections
Total
11 cities with
population > 100,000
42.0
14.1
2.0
4.7
62.8
38.0
17.3
4.5
5.8
65.6
47 cities with
population > 30,000
35.1
13.4
2.2
4.8
55.5
Source: Balestre & Gilletta, 1901, pp. 13, 17.
The mainly ‘exogenous’ source of IM was verified in nearly two thirds of cases with
infectious carriers invariably playing an important role. The prominence of diarrhoea points to
the inadequate feeding of babies as well as to the unsanitary conditions still prevailing in the
populous neighbourhoods of cities as in the country during the ‘Belle Epoque.’ Thus, IM is a
prime example of the ‘paradoxes of modernization’ in the then developed economies which is
discounted among the other, most conspicuous signs of progress.
1.3 The geography of infant mortality
In the second half of the 19th Century only three departments exhibited crude IMRs
steadily close to an IM of 100‰ or the average level of Ireland (Creuse, Landes, Vienne) with
another two or three close to the mark (Charente, Vendée). All were located in the SouthWestern quarter of the territory which had lower IM than in the North and South East.
Generally speaking departments with lower IM were invariably situated south of the line
running from St. Malo to Marseille typically regarded as the frontier between the modern,
urbanised and industrialised northern half and the backward, rural and agricultural South.
Cursory inspection of the geography of IM at regular intervals further suggests that IM was
commanded by different factors sometimes in similar environments. Thus, mountainous areas
could be conducive either to high IM as in the Alps or low IM as in the Pyrenees. Upper
Normandy had an above average IM whereas lower Normandy had a below average. The
Rhone valley was unhealthy but Lyon and its surroundings despite the early development of
8
industry had below average IM. Thus departments with high IM could be either ‘modern’
densely urbanised and industrialised, or, conversely, ‘backward’, rural and retarded, illequipped to find the ways for improving the health of young children. IM therefore seems to
have been commanded by a variety of factors which the contemporary and recent literature
can help disentangle.
Table 3. Instances of rural and urban departments with high or low IM
high IM
low IM
rural
• Cantal, Ardèche: primarily
agricultural, marginal territories on
fringes of Massif Central
• Eure, Orne (Normandy):
primarily agricultural with access
to urban markets
• Gard: malaria endemic on coast;
mountainous and poor in the North
(Cévennes)
• Pyrenees (Western side):
mountainous, agriculturally poor
• Poitou-Charentes: relatively
prosperous agriculturally
• Landes: flat, sandy, poor
• Berry: relatively prosperous
agriculturally and no industry
urban
• Haut-Rhin (Mulhouse), SeineInférieure (Rouen): populous bastions
of textile industry
• Vaucluse (Avignon): backward area
along lower Rhône valley
• Seine-et-Oise: Paris suburbs with
extensive urban and industrial
development
• Rhône (Lyon): industrial cluster
(silk) surrounded by mountains
• Ardennes (Sedan): rugged, wooded
area with industrial tradition (wool)
• Gironde (Bordeaux): important port
city with agriculturally rich hinterland
2. Bringing up babies in the shadow of Dark satanic mills
2.1 The-urban industrial penalty
The statistical evidence already struck contemporary observers and social reformers:
“cities with the highest [infant] mortality are either port cities or industrial centres” (Balestre
& Gilletta, 1901, p. 30) and our two doctors lament in unison with other colleagues the
“effrayante mortalité des villes ouvrières.” By the end of the 19th Century the department of
the Nord held the sad record of registering the highest rates of IM in the land (especially in
Roubaix, Lille, Dunkirk, Calais and Tourcoing). The curse extended to urban centres of more
modest size, with typically under 30,000 residents, such as St. Pol-en-Mer which registered a
staggering 500‰ IMR over 1892-97. In addition to the poor sanitary conditions and pollution
of 19th Century towns, the employment of young mothers in industrial occupations was
9
believed to be first and foremost responsible for their the lack of parental attention suffered by
young infants and their frequent loss.
As a first approach, the connection was tested by observing the correlation between IMRs
and the proportion of the labour force employed in manufacturing industry – establishments
employing ten workers or more, which represented between 20 and 25% of the total industrial
labour force. Of the five benchmarks available (1841, 1861, 1872, 1896 and 1906) the
correlation is strongest for 1872 at a time when IM deteriorated across France following the
turmoil caused by the Franco-Prussian war. The effects of industrial employment are positive
but its impact is still relatively weak (r-square=0.13).
There are a number of reasons why that should be so and the share of manufacturing
employment should reflect only imperfectly the disamenities/hardships incurred in urban
industrial centres. If contemporary doctors were right, it is the employment of women in
industry (establishments of all type regardless of their size) which should be taken into
account. In ‘small industry’ (or crafts) working conditions could be likewise strenuous though
in a different way than in large factories (typically textile mills). Numerous young women
with good eye-sight could find occupation in the finishing stages of the textile and garment
industry; their wage and working time conditions, surveyed by the authorities from 1853
onwards, do not appear to have been much more enviable.4 However, female employment in
factories which can be assessed more straightforwardly can serve as a reliable proxy.
Furthermore, the weakness of the correlation could be accounted for by the fact that rare
were the departments where a sizeable share of the working population was employed in
manufacturing (in only four cases was this share superior to 8%). Obviously other forces were
at work which pushed IM up or down.
2.2 Influence of the standard of living
At the country level correlation between infant mortality and per capita income is very
robust and confirms the intuition that infant mortality tended to fall with rising incomes. At
the regional level inside a country this income effect is very difficult to capture especially in
the absence of standardised regional GNP per capita for the period in question. Of the proxies
at our disposal, direct indicators such as real wages (measured as “welfare ratios”) yield
They covered 12 professions typically exercised by women in ‘small industry’ and included embroiderers,
dressmakers, lacemakers, milliners and makers of corsets, underwear, artificial flowers, waistcoat and women’s
boots as well as laundry and charwomen.
4
10
disappointing results. The extent of the problem is highlighted by the contrasting features of
the two panels of data at hand: wage rates varied much less across departments than did IM5
and the upward trend in real wages after 1870 runs against the stagnation of IM in this period.
Thus on a first impression the improvement of individual income in money terms seems to
have had little bearing on the condition of the newly born. However, the improvement in IM
during the last four decades of the century seems positively correlated to the almost general
rise in living standards during this period.
Figure 5. The course of real wages in France in the 19th Century (1900=100)
120
100
Paris
(1900 = 100)
80
France
60
40
20
0
1820
1830
1840
1850
1860
1870
1880
1890
1900
1910
1920
Source : Kuczynski, 1967.
By contrast, instantaneous cross-section correlations appear very weak. It is probable that
at still relatively low income levels (around, say, $2,000 per capita) regional variations had
only marginal effect on the standard of living and the quality of life of families. General
income indicators for the 19th Century may be also too coarse and consumption indicators
could be preferable. Ever since McKeown’s work, emphasis has been laid on the
improvement of nutrition as a means to bring down IM. In this respect endemic or chronic
food shortages had more damaging effect than harvest failures. Regarding relative food
abundance or scarcity, standard historical accounts of France’s situation produce send signals.
5
The dividing line was between wage rates in the Paris area and in the rest of the country.
11
According to some France was a land of plenty, the major foodstuff producer in Western
Europe, especially during the prosperous years of the Second Empire, which witnessed the
generalisation of white bread (Kaplan, 2006). By contrast recent evaluations of the daily
caloric intake put French masses at the low end of the spectrum. On one estimate it is believed
to have been kcal 1,670 per person in 1870 (Fogel, 2004, p. 12). Here the contrast between
agriculturally rich and agriculturally poor departments should become apparent but the
adequate instrument for the impact on their residents’ nutrition is delicate. Data on the price
of bread which is well-documented from the mid-19th Century turns out to be a blind alley,
probably because a large share of the rural population still made its own bread at the fraction
of the high street price typically taken as the standard in price surveys. For those years when
authorities tried to assess bread consumption per capita (as for 1888) those departments where
the urban population could afford to buy more and better bread seem to have enjoyed lower
IM. This leaves the problem of rural areas with high IM. But agricultural production statistics
available at ten years’ interval from 1840 onwards are a poor help because the interregional
trade in foodstuffs was already very developed by this time.
An other provision which could have influenced IM more directly is of course milk. But
there again the information at our disposal sends mixed signals. Estimates of milk production
and prices are available from the second agricultural survey (1852) and one might expect that
milk tended to be consumed or transformed locally, and that this should reflect on the survival
rate of infants. However, pasteurisation took hold only at the turn of the 20th Century6 and
crude milk could transmit TB, which was endemic among the horned cattle at the time. This
could account for the fact that Balestre & Gilletta found a TB related condition among 15 to
20% of the recorded causes of death of infants in towns of 30,000 people or more (it was
particularly prominent in Paris). Another could be that urban working class families were
reluctant to purchase fresh milk for feeding the young. Most (as among the miners described
by Zola) believed it an extravagant and superfluous expense and such an attitude was usually
reinforced by local customs advising, as in the Nord (with an IMR of 284‰ in 1897), to feed
babies on a mixture of whey (or lacteroserum – the residue from freshly strained cheese)
thickened with flour – a mixture (under the name of ‘petit pot’) fatal to almost one infant in
five in that period (Pierrard, 1976, p. 33).
6
In spite of its name, pasteurized milk owes its origin not to Louis Pasteur but to the German chemist Franz von
Soxhlet (1848-1926) who recommended this procedure in 1886. Pasteur had taken out a patent for preserving
wine in 1865. A charity established in Normandy (and still active today) ‘La goutte de Lait’ started campaigning
for the proper feeding of babies in 1894.
12
Another way of probing the influence of the standard of living on IM is through the data
provided on the height or health condition of conscripts at the time they underwent the
physical examination for military service. Figure 6 seems to suggest that the course of
nationwide IM and average height run in parallel. Also, at the department level, the
proportion of young men declared unfit for military service (mainly for physical ailments but
also for insufficient height) was correlated (with the usual 20-year lag) to IM. In view of this,
the ‘biological standard of living’ as measured by conscripts’ height (with the appropriate
correctives) appears as one of the more promising alleys to investigating the impact of
material conditions on the chances of survival of the young during this period.
Figure 6. The course of infant mortality and the average height of conscripts 1850-1913
167
250
166,5
average height of conscripts (cm)
165,5
200
150
165
164,5
100
average height
infant mortality rate (‰)
infant mortality
166
164
50
163,5
163
0
51 55 59 63 67 71 75 79 83 87 91 95 99 03 07 11
18 18 18 18 18 18 18 18 18 18 18 18 18 19 19 19
Sources: Weir (1997), Nadot (1970).
2.3 IM as one of the attributes of destitution
Physicians and social reformers were also unanimous in observing that infant mortality
was particularly severe among the poor and there should be prima facie a relation between the
proportion of the destitute in one area and the infant mortality recorded there. Poor relief was
13
never as extensive in 19th Century France as it was under the Poor Law in England7 but some
form of assistance organised by the state or local authorities did exist. The most general form
of poor relief was provided by the ‘bureaux de bienfaisance’ normally present in all the main
localities. A count of paupers on poor relief was published by department and it provides an
approximation of the extent of destitution but at irregular intervals. Public largesse depended
not only on the needs of the underclass but also on the wealth and willingness of local
councils. Thus Calvados, an agriculturally rich department with ‘socially responsible’
industrialists had more families on its relief rolls than did the Nord.
Here again the relationship is positive since the two indicators are both biased towards
urban communities. As E. Buret already remarked in the 1840s: “The destitute belong
overwhelmingly to the population of cities and towns with at least 5,000 inhabitants” (Buret,
1840, I p. 254). The ‘fit’ is quite good for the major metropolitan areas which could afford to
extend poor relief to a proportion of their population above the national average (3.4%). But it
leaves out the poor rural departments with high IM and low assistance capacity.
3. Industrialization is not the whole story
Obviously the urban-industrial development complex doesn’t exhaust the determination of
IM levels.
3.1 Availability of obstetric services
It was a recurrent complaint by medical practitioners and propagators of ‘modern science’
in the 19th Century that a number of obstacles, technical and cultural, lay in the way of
medical progress generally and the low surviving rate of young children. One such obstacle,
one upon which the original United Nations health report of 1953 laid great stress was the
availability of medical practitioners, especially midwives. From the occupation census of
1851 we can obtain the numbers in this profession exercising in each department; from 1871
onwards the provision of such information became annual (they are sometimes at variance
with the numbers supplied by the census). The relation between this variable and the IMR has
been assessed at 5-year intervals. Except for 1851 and the 1860s (during which the
7
On the eve of the revision of the Poor law (1833), the French government spent FF10m on bureaux
d’assistance (as they were then called); that year cumulated poor rates in England represented £8.7m (or twenty
times that amount).
14
“midwives” category is blended into one grouping all “medical professions” by sex), the
relation is always as one would expect: the more midwives there were in a department, the
more likely IM tended to be low. As can be seen in Table 3, the ‘fit’ tended to improve over
time.
The availability of obstetric services seems therefore, among all the factors so far
investigated, to have been one of the more potent factors in the reduction of IM during the
crucial last three decades of the 19th Century.
Table 3. The relation between the numbers of registered midwives and IM, various years
1851
1856
1861
1866
1872
1876
1881
1884
1891
1901
1906
1911
Variable
Midwives
“
Medical professions (F)
“
Midwives
“
“
“
“
“
“
“
Relation
+
–
+
+
–
–
–
–
–
–
–
–
R2
0.04
0.01
0.01
0.05
0.01
0.06
0.10
0.12
0.14
0.18
0.25
0.60
3.2 Women’s education
The level of education attained by women in still predominantly traditional societies is
believed to have had a powerful influence on the health of their children in the first years of
their existence. The level of literacy prior to the introduction of mandatory elementary
education (1881) can be ascertained from a number of surveys conducted from the late 1820s
from marriage records: the ability to sign the marriage certificate is taken as proof that the
spouse is literate. Until mid-century a NE-SW divide split the French territory between
departments with literacy rates above 50% and those with lower rates, often much lower in
the case of women. Whether the relation is probed at this date or towards the end of century
the connection between low literacy rates and high IM seems warranted. In the last decade of
the 19th Century eight of the departments with above average IM recorded also female
illiteracy above the 30% mark. This suggests that, along with the availability of midwives,
elementary education seems to have been a powerful tool to bring down exogenous infant
mortality.
15
3.3 Aggravating circumstances
The rise in alcohol consumption was a favourite whipping boy among end-of-the-century
hygienists and it became a prime concern of medical experts even if the authorities lent a deaf
ear to their concerns for a long time. Alcoholic beverages (other than wine) were a prime
source of revenue for the state and as such monitored and taxed; at the same time successive
governments were careful to accommodate the ‘bouilleurs de cru’ (private distillers), a
powerful constituency and interest group. Statistical evidence suggests a steep rise in personal
consumption all along the 19th Century, with an acceleration in the 1870s. The fall out
apparent on Figure 7 below after 1900 could be the result of a statistical artefact: some
‘bouilleurs de cru’ (or private producers) were exempted of the tax after a law passed in 1899.
In all likelihood the official numbers provide a lower bound estimate of actual consumption.
Figure 7. (Pure) Alcohol and wine consumption per capita, France 1830-1913
5
250
vin (litre)
4,5
alcool (litre)
200
wine consumption (litres per cap)
alcohol consumption (liter per cap)
4
3,5
3
150
2,5
2
100
1,5
1
50
0,5
0
1830
0
1840
1850
1860
1870
1880
1890
1900
1910
The origins of this surge in alcohol consumption are not well known. Zola and others
popularized the idea that it was inherent to the lifestyle induced by factory work or in the
collieries. It is striking in the French case, however, that alcohol consumption could be as
high in industrial as in rural areas. To Balestre & Gilletta, the connection at the department
16
level between high infant mortality and high alcohol consumption was obvious (Balestre &
Gilletta, 1901, p. 49) and we have attempted to verify this.
Figure 8. (Pure) Alcohol consumption per capita, various countries c. 1890-9 average
8
Pure alcohol consumption per capita (litres)
7
6
5
4
3
2
1
0
s
ark
um
nd
lgi
nm
rla
e
Be
h
De
t
Ne
n
y
e
d
nc
de
an
an
rm
we
erl
Fra
e
S
z
t
i
G
Sw
UK
a
ssi
Ru
US
ly
Ita
4. Probing the determinants of infant mortality
In this section we attempt to highlight the combined effect of explanatory variables to
account for IMR variations across departments using polled cross-section data analysis.
Drawing on observations in the previous sections we can expect that a higher standard of
living or improved nutrition as well as higher education levels and access to obstetric services
could have had a beneficial impact on IM while industrialization as well as alcohol
consumption and lower levels of per capita income could have a negative effect (i.e. raising
IMR).
We focus on the period of persistent high IM spanning the years 1850 to 1891 and our
dataset uses 1851, 1861, 1871, 1881, and 1891 as benchmarks. For each benchmark panel
data include, at the department level, in addition of average IMRs, the ratio of midwives to
17
births, the average wage rates (nominal) in urban industry, as well as the average height of
conscripts used as an indicator of the biological standard of living. As mentioned earlier, IMR
has been adjusted by taking into account what is described in the sources as “stillbirths and
infants who died before birth registration”.
As outlined previously it is difficult to set aside the role potentially played by medical
personnel – although this could be an anachronism for the 19th Century – and especially by
the availability of obstetric services. We have selected midwives for three reasons. Firstly, as
members of the female sex they were more likely to be associated with childbirth and
childcare (as the literature suggests). Second, their numbers are more stable across the period
under scrutiny (second half of the 19th Century) and third, their distribution is much less
skewed towards large cities than were for instance male medical practitioners. From 1871
their qualifications were apparently reviewed and verified annually by the authorities. Given
the consistency of regional distribution of these numbers across the period, it is believed that
they are dependable.
For the vast majority of people, physicians were only sent for in the last resort, especially,
as Dr. Knock complained in the famous play by Jules Romains (1923), in order to obtain the
death certificate after the demise of the patient. It is unlikely therefore that the greater density
of medical practices could account for relatively lower levels of infant mortality.
The health economics literature points to the decline of IMR associated with the diffusion
of primary education after WWII (Linderboom et al. 2009). More generally, the education of
women is generally perceived as having a positive influence on the health of the children. As
a proxy for measuring female education level, we rely on the literacy rate recorded by
government authorities on the basis of the share of female spouses able to sign the marriage
declaration.8
Among indicators of nutritional status that can be assessed at the regional level, the most
dependable seems the availability of milk that has been already identified in previous research
as having had a significant effect on the biological standard of living in 19th century France
(Baten 1999). For most years, except 1862, data are missing for a handful of departments but
the levels appear fairly stable for the rest of the sample; we use therefore data for 1862 as
tentative explanatory variable for all years for which IMRs have been computed. The milk
variable expressed in litres per capita is not equivalent to milk consumption as such but
measures the quantity produced in each district (goat milk important in the South was added
8
These data were computed for 1854-55, 1861-65, 1871-75, 1880 and 1892, and used as proxy for 1851, 1861,
1871, 1881, and 1891, respectively.
18
to cow milk). Although a sizeable share of output was of course processed as butter or cheese,
it was assumed that the relative abundance of milk in one district could reflect on its
availability for the purpose of feeding babies. The regional variance in the price of milk
relative to bread, that can be computed for a few years is however consistent with the variance
in milk availability, suggesting that this second indicator is indeed dependable.
As already noted 19th Century alcohol consumption also (although reported as such)
suffers also from inadequate reporting. Changes in the tax schedule particularly may render
year-to-year variations inconsistent. This defect was particularly conspicuous at the turn of
the 20th Century. Another caveat arises from the fact that these figures are based on legal
transactions and that an unknown portion of consumption evaded tax and therefore reporting.
For similar reasons as for milk availability, i.e. missing or inconsistent data for a few years,
alcohol consumption in 1886 was used in the regression analysis.
To assess the impact of industrialization on the IM we use the share of the labour force
employed in ‘grande industrie’ (manufacturing and mining) in line with the observation that
factory work had a deleterious effect on the health and parental capability of young mothers.
However, coverage doesn’t appear to be consistent over the years probably because
sometimes workshops qualified as factories and sometimes not9. In spite of the loss of
information, we used the figures of 1861 that appear particularly consistent for all other years.
Finally, we introduced in the analysis department-level data regarding the percentage of
households on poor relief. This information is available for 1875. Here again we used this
series for all years.
Tables 1 presents the estimation results of the OLS regression of pooled cross section data
for the years 1851, 1861, 1871, 1881, and 1891 (1a) and for each individual year (1b, 1c, 1d,
1e, 1f). In addition to the variables mentioned above, all in log-log form, year dummies have
been plugged in in order to capture differences in the prevalence of transmissible diseases. In
particular, the overall level of IMR was unusually high in 1871, “l’année terrible” as it has
been called: the dummy for 1871 is omitted in this pooled cross section. We do not use panel
data analysis and therefore neither department fixed effects nor random effects are included in
the regression analysis. Fixed effects are not suitable because the figures for industrialization,
milk availability, and alcohol consumption are based on observation for only one year. The
inclusion of fixed effects implies therefore dropping these variables. Random effects are not
9
The industrial classification developed in the 1866 occupational census which took as a basis the businesses in
which people worked to establish their profession was abandoned between 1872 and 1896 (when this procedure
was resumed) and this change could account for the wavering dividing line between ‘grande’ (factory industry)
and ‘petite industrie’ (crafts).
19
suitable either because there is no reason for assuming that these effects are uncorrelated with
the independent variables (which is the condition using for random effects).
Table 4. Estimation results for all years and for individual year
Midwives
Factory work
Milk
Poor relief
Female
literacy
D1851
D1861
D1881
D1891
Intercept
Adj-Rsquared
Observations
1a
(all years)
-.074***
.049***
-.037***
.022*
.232***
1b
1851
-.065**
.052**
-.072***
.021
.184***
1c
1861
-.094***
.054**
-.037**
.009
.297***
1d
1871
-.069**
.034
-.018
.016
.237***
1e
1881
-.077**
.036
-.046**
.010
.302***
1f
1891
-.091**
.062**
-.021
.032
.435***
-.404***
-.171***
-.297***
-.331***
4.955***
0.572
428
4.894***
0.446
84
4.583***
0.422
87
4.843***
0.2053
85
4.434***
0.181
86
3.667***
0.159
86
Note: *, **, *** significant à the 10%, 5%, and 1% levels respectively.
The results presented in Table 4 show that a number of coefficients for independent
variables are significant and of the expected sign: the number of midwives and milk
availability reduce IMR, whereas a large share of the labour force engaged in manufacturing,
and a high share of households on poor relief increase mortality levels. The coefficient for
nominal wages is not significant; for between half to two thirds of the French population
living in the country, nearly half of all food production (40% in 1870) was self-consumed
(Lévy-Leboyer & Bourguignon, 1990, p.). The same remark applies to alcohol consumption:
rural communities produced for their own needs (hence the tolerance of authorities). In urban
areas, alcohol consumption reduced the share of lower income households available for the
purchase of quality foodstuffs (e.g. milk products). A positive and significant coefficient is
obtained for female literacy; contrary to expectations, the sign is the opposite of what could
be expected and what is verified for the post WWII period. The most plausible inference is
that, although IM was lower among the educated middle class than among the uneducated
working class female (basic) literacy was a poor insurance against the exposure to
transmissible diseases, and an inadequate indicator of maternal attention.
The coefficients observed with the pooled cross section regression (1a) indicate that the
elasticity for the share of the labour force in manufacturing was around 0.05, i.e. 5% change
in IM was associated with a level of industrialization 100% higher, and around 7% for
20
midwives, 4% for milk, and 23% for female education. Since differences in basic female
literacy faded towards the end of the century, the number of midwives, factory work, and milk
availability can be regarded as the most important explanatory variables of the regional
variance in IMR. The results 1b to 1f show that the midwives and female literacy effect is
observed for all years, while the influence of factory work and milk becomes blurred. Overall,
the explanatory power of the regression is strong at an earlier stage of industrialisation in
1851 and 1861, and appears weaker in the last three decades of the century.
Table 5 presents the same regression performed for subsamples 2a and 2b with above
and below average IMR, 2c and 2d for midwives’ numbers above and below average, and 2e
and 2f for share of the labour force engaged in factories above of below average. It turns out
that the results for the main explanatory variables (midwives, factory work, milk availability,
and female literacy) are not very sensitive to the exclusion of part of the sample on these
different criteria. For these variables, most coefficients remain of the same sign and
significant. The only exception is for the share of the labour force engaged in factory work
when the IMR is above average; this doesn’t come as a surprise because high IM was reported
in industrial towns but also in remote rural areas. The magnitude of the coefficient is roughly
of the same order, between 0.05 and 0.9 for midwives, 0.04 and 0.09 for factory work, 0.02
and 0.07 for milk, 0.14 and 0.27 for female literacy.
Table 5. Estimation results for subsamples (all years)
Midwives
Factory work
Milk
Poor relief
Female literacy
D1851
D1861
D1881
D1891
Intercept
Adj-Rsquared
Observations
2a
2b
2c
2d
2e
2f
IMR < av.
IMR > av.
midwives<av.
midwives>av.
Indus. <av.
Indus.>av.
-.050***
.042***
-.024**
.023*
.139***
-.094***
-.093*
-.053
-.054
4.860***
0.230
221
-.063***
.007
-.018***
.008
.182***
-.203***
-.086***
-.164***
-.203***
5.118***
0.366
204
-.087***
.037***
-.071**
.032*
.213***
-.418***
-.169***
-.302***
-.309***
5.243***
0.577
247
-.089**
.063***
-.017*
.028
.268***
-.409***
-.179***
-.293***
-.352***
4.739***
0.594
181
Note: *, **, *** significant à the 10%, 5%, and 1% levels respectively.
21
-.078***
.046**
-.038***
.031**
.237***
-.397***
-.186***
-.303***
-.349***
4.956***
0.524
296
-.065**
.087***
-.035**
.007
.210***
-.420***
-.140***
-.285***
-.287***
4.956***
0.599
132
Conclusion
Although a strong negative correlation between infant mortality and average height is
typically observed when relying on time series for 19th and 20th Century European countries,
there was almost no relation using cross sectional regional data for 19th Century France. Both
infant mortality rates and average height were low in some rural regions, while high levels
were observed in most urban industrialised areas.
The investigation of the socioeconomic determinants of infant mortality presented in this
paper allows explaining the reasons for this mismatch. Among the variables identified by
Weir (1997) and Baten (1999) as having a positive influence of regional level average height
of conscripts in 19th century France, milk is the only one reduce IMR. Average regional
wages, which is a major explanatory variable of height, did not play a significant role.
Unexpectedly, female literacy that has been identified as having a positive influence on height
tends to increase IMR. Other variables that were not included in the analysis of the
determinant of height mentioned above have a significant influence on IMR. As expected,
factory work and poor relief tend to increase IMR while the number of midwives lowers
infant mortality. Although alcohol consumption was regarded by medial experts of the 19th
century as a major cause of IMR, this claim is not supported by quantitative evidence.
Additional investigation reveals, unsurprisingly, that average regional level IMR for a
given cohort year had only a modest (but significant) influence on average height of
conscripts measured at age 20, and that the variation of IMR over 5 or 10-year periods was
unrelated to the variation of average height with a 20-year lag. These results highlight that, in
19th Century France as in other settings, welfare is multidimensional. The socioeconomic
determinants of IMR deserve further investigation. In particular, the puzzling negative
influence of female literacy on IMR is likely to be due to other unidentified variables. In
addition, it seems desirable to take into account the regional variance in the prevalence of
transmissible diseases such as TB and syphilis that are identified in the medical literature as
possible explanatory variables of IMR.
22
Statistical appendix
Annual rates of infant mortality have been computed at five-year intervals from the mid19th Century on the basis of the numbers of the deaths under one year of age provided by the
“statistique du mouvement de la population” published in the following publications from
1853 which provide also the numbers of births, stillbirths and ‘deaths before birth
registration’:
-
1853-1870 Statistique de la France, IIe série, vol. I-XXI (1855-1873)
-
1871-1899 Statistique de la France, Nouvelle série, Statistique annuelle (1872-1885)
-
1898-1910 Statistique annuelle du mouvement de la population et des institutions
d’assistance vol. 28 – vol. 40
-
1911-1914 Statistique du mouvement de la population d’après les registres d’état-civil
Detailed statistical information on infant mortality for most municipalities of at least 5,000
residents is available from 1885 in the Statistique sanitaire des villes de France et d’Algérie
(1e partie : vol. I (1886) – vol. 29 (1914) 2e partie : 1e année (1906) – 8e année (1913).
23
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