Louis-Rene Villerme (1782-1863), a pioneer in social epidemiology: re-analysis of his data on comparative mortality in Paris in the early 19th century.
BACKGROUND
During the early 19th century, contagionists' and anti-contagionists' explanations of disease causes opposed one another, and the Hippocratic miasma theory still predominated. According to that theory, geographic health disparities could be explained by topographical factors: differences in altitude, population density or proximity to a river. This article summarizes the life of Louis-René Villermé (1782-1863) and his major contributions to social epidemiology that proved the association between poverty and mortality.


METHODS
In this study, data reported by Villermé to study the mortality-rate variations across the 12 districts (arrondissements) of Paris-that is, 1817-1826 Parisian death rates by district, population density and income indicators-are presented and reanalyzed.


RESULTS
Results obtained with today's statistical techniques (correlation analysis) support Villermé's claims of a direct poverty-high death rate link: the three income indicators that he chose were significantly correlated with at-home mortality: taxation index (r=-0.83, p<0.002), average rent (r=-0.83, p<0.002), trade taxation index (r=-0.67, p<0.05), while population density variables were not associated with mortality.


CONCLUSIONS
Villermé was not only a forerunner of social epidemiology, he was also a scientific pioneer by relying on data, not opinions, to challenge or support medical hypotheses.
Julia
C
C
AP-HP, Hôpital Saint-Antoine, Unité de Santé Publique, Paris, France. julia@u707.jussieu.fr
Valleron
A-J
AJ
D003627:Data Interpretation, Statistical; D016021:Epidemiologic Studies; D049672:History, 19th Century; D006801:Humans; D009026:Mortality / Q000639:trends*; D010297:Paris / Q000453:epidemiology; D011156:Population Density; D011203:Poverty