The transformation of cities and towns from demographic sinks to self-sustaining population centres in the late eighteenth century may also have coincided with the emergence of significant differences in mortality by social class. In England wealth

Introduction Today it is generally the case that urban dwellers enjoy higher life expectancy than their rural counterparts, globally. This urban advantage is partly attributable to the higher average incomes of urban dwellers, as well as superior access to public health services, including water supply and sewage disposal, and medical services. However this was not the historical norm. In the seventeenth and eighteenth centuries European cities operated as ‘urban graveyards’, with very high mortality rates, and required a net flow of inmigrants to maintain their population size. Wrigley has estimated that half the natural growth of the English population in this period (births in excess of deaths) was consumed by London’s mortality regime. Kuznets argued that excessive urban mortality rates precluded modern economic growth, with its concomitant rapid urbanisation, because no population could produce a rural population surplus sufficient to maintain a very large urban component. However in the last quarter of the eighteenth century a dramatic change occurred in a large number of towns and cities in north-western Europe, and baptisms began routinely to exceed burials. Nevertheless although many cities became capable of natural growth in the late eighteenth century, an urban mortality penalty persisted across the nineteenth century, and cities only exceeded rural life expectancies in the twentieth century.