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MORTALITY CHANGE IN HERMOUPOLIS, GREECE (1859-1940) Michail Raftakis Thesis submitted for the Degree of Doctor of Philosophy in accordance with the requirements of the Newcastle University. School of History, Classics and Archaeology September 2019 Abstract This thesis examines mortality decline from 1859 to 1940 in the city of Hermoupolis, on the Greek island of Syros. A demographic approach is employed to understand the mechanisms of mortality decline at both local and national levels. This study produces important new insights into Greek and Mediterranean urban historical demography and is the first comprehensive study of urban mortality in Greece, utilizing the largest and one of the longest time-series yet calculated from civil registration and census data. Standard historical demographic methods were employed in this study along with the technique of nominal record linkage. A series of abridged life tables was constructed for the very first time for a Greek urban settlement, enabling the calculation of age- specific mortality rates and life expectancy. Cause-specific mortality analysis for the years 1916–1940 provided a deeper insight into the epidemiological profile of the city. Hermoupolis experienced much higher mortality levels than the national average. The findings presented here suggest that early childhood mortality started to decline rapidly as a result of mass immunisations from the late nineteenth century onwards, with declines in early adulthood and infancy following. This thesis has found that the second stage of Omran’s epidemiological transition theory was still ongoing in the 1930s, with high prevalence of infectious diseases, especially of tuberculosis among young adults and diarrhoeal diseases among infants and young children. Exceptionally high mortality levels were also recorded during the 1918 influenza pandemic. This thesis reinforces and confirms our limited knowledge about the timing of the mortality transition in Greece. It proposes that an urban penalty was clearly operating in the country even during the first decades of the twentieth century. Finally, this thesis suggests that a combination of factors was responsible for the mortality decline in Hermoupolis, including wider access to water, which even when it was not clean enough to drink, it nevertheless enabled improvements in personal hygiene among the residents of the city. ii To my parents and my beloved grandparents, Σάσα and Σήφη iii iv Acknowledgements I would like to express my gratitude to all the people who helped me at various stages in the production of this thesis. First of all, the staff of the General State Archives of Syros. I am highly indebted to Angeliki Psilopoulou and Taina Hietala, who welcomed me, accommodated me, answered all my questions and passing their knowledge of Syros to me. Pope Paschalidou and her family made my stay in Hermoupolis very pleasant. I would like also to thank the Mayor of Hermoupolis Giorgos Maragkos who granted me access to the data. I am grateful to Irene Kostara, the registrar, who made my time in Hermoupolis more enjoyable. I am in debt to Hara Skavaki and the staff of the Municipal Library of Hermoupolis for their patience and help. In addition, I give deep thanks to the librarians of the Library of the Hellenic Parliament and the National Library of Greece in Athens, who were very helpful. I would like to thank all my PhD colleagues, with whom I have shared moments of deep anxiety but also of big excitement. I am extremely grateful to my friends in Newcastle, Chania and elsewhere for providing me the necessary ententainment and support. A warm word to Helen for proofreading parts of my thesis and to Edu for drawing the map of Greece. Special thanks to my friend Angeliki, who has encouraged me constantly along the way. Without our very long discussions, this thesis would have been a less pleasant experience. I owe an enormous personal debt to Willem for his generous time and support. I would like to express my sincere gratitude to my supervisor Dr. Violetta Hionidou for her ongoing support, patience, motivation and immense knowledge. She has guided me and encouraged me to carry on through these years and has contribured to this thesis with a major impact. I would like also to thank Professor Jeremy Boulton, my second supervisor, for his insightful comments and encouragement. Above all, a very special word of thanks goes to my family. I will always be grateful to my parents who supported me emotionally and financially to complete my thesis and also my studies. They have been always there for me. This thesis is dedicated to them and my grandparents. Efharisto poly! Newcastle, September 2018 v vi Table of Contents ABSTRACT ............................................................................................ I ACKNOWLEDGEMENTS ...................................................................... V TABLE OF CONTENTS ....................................................................... VII LIST OF FIGURES .............................................................................. XII LIST OF TABLES .............................................................................. XVII LIST OF PLATES ............................................................................... XIX CHAPTER 1. INTRODUCTION ............................................................... 1 1.1 INTRODUCTION .......................................................................................................... 1 1.2 MORTALITY PATTERNS IN EUROPE (MID-19TH -MID-20TH C.) ........................................ 2 1.3 INFANT AND CHILDHOOD MORTALITY ..................................................................... 9 1.3.1 EARLY CHILDHOOD MORTALITY PATTERNS ........................................................... 9 1.3.2 INFANT MORTALITY PATTERNS .......................................................................... 12 1.4 WHY GREECE? .................................................................................................... 16 1.5 WHY HERMOUPOLIS? .............................................................................................. 18 1.6 RESEARCH QUESTIONS ............................................................................................. 20 1.7 THE STRUCTURE OF THE THESIS ............................................................................... 21 CHAPTER 2. HERMOUPOLIS, SOURCES AND RECORD LINKAGE ..... 23 2.1 INTRODUCTION ....................................................................................................... 23 2.2 THE HISTORY OF THE CITY ....................................................................................... 23 2.3 ANO SYROS ............................................................................................................. 29 2.4 HERMOUPOLIS DATA SOURCES ................................................................................. 31 2.4.1 CENSUS SOURCES ............................................................................................. 31 2.4.2 CIVIL REGISTRATION ........................................................................................ 32 2.4.3 SECONDARY SOURCES ...................................................................................... 38 vii 2.5 NOMINAL RECORD LINKAGE PRACTICE ...................................................................... 38 2.5.1 CONSTRUCTION OF DATABASES AND DATA INPUTTING ........................................ 39 2.5.2 RECORD LINKAGE ........................................................................................... 40 2.6 HERMOUPOLIS SOURCES: A CRITICAL EVALUATION .................................................... 43 2.7 CONCLUSION ........................................................................................................... 45 CHAPTER 3. SANITARY REFORMS IN HERMOUPOLIS ..................... 48 3.1 INTRODUCTION ........................................................................................................ 48 3.2 SANITARY REFORMS ................................................................................................ 48 3.3 PUBLIC HEALTH IN GREECE ..................................................................................... 51 3.4 PUBLIC HEALTH IN HERMOUPOLIS ........................................................................... 56 3.4.1 PUBLIC HYGIENE .............................................................................................. 56 3.4.2 WATER-SUPPLY AND SEWAGE DISPOSAL IN HERMOUPOLIS ................................. 64 3.4.3 MEDICAL SERVICES AND PRIVATE/CHARITABLE ACTIVITY ................................... 71 3.5 CONCLUSIONS ......................................................................................................... 74 CHAPTER 4. MORTALITY PATTERNS IN A GREEK URBAN SETTLEMENT ...................................................................................... 75 4.1 INTRODUCTION ........................................................................................................ 75 4.2 CRUDE DEATH RATES ............................................................................................... 75 4.2.1 MORTALITY RATES IN GREECE ............................................................................... 75 4.2.2 MORTALITY LEVELS IN HERMOUPOLIS, 1859-1940 ............................................... 83 4.3 LIFE TABLES ............................................................................................................ 87 4.3.1 CONSTRUCTION
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