Individual-level causes of death in Portugal, 1834–1910. Their potential and pitfalls for studying health inequalities

Abstract

This paper assesses the potential of Portugal's individual-level death certificates with stated causes of death by a physician (1834–1910), arguing that, despite assumptions of documentary scarcity, significant collections survive and can support the study of mortality and health inequalities. It outlines the historical trajectory of death registration with emphasis on liberal reforms initiated in 1837 which introduced physician-certified death certificates and burial tickets, intended to standardize cause-of-death reporting and generate data for public health administration. Implementation was uneven due to limited cemetery infrastructure, bureaucratic fragmentation, and popular resistance, but coverage expanded notably from the 1870s. Archival surveys reveal strong regional variation: some districts, including Porto, Lisbon, and Horta, achieved high coverage, while others show only partial or irregular adoption. Using Porto as a case study, the article presents the development of a new database (1869–1910) based on digitized certificates and burial tickets. Preliminary results demonstrate high representativeness, decreasing numbers of missing causes of death, and growing conformity with official nosologic classifications. Improvements are particularly visible in stillbirth reporting, child mortality diagnoses, and rural parishes. The database is being integrated with a historical GIS to support spatial analysis of mortality and living conditions. The article concludes that, despite gaps and losses, surviving certificates constitute a valuable and underused resource for investigating mortality patterns, public health policies, and socioeconomic inequalities in 19th-century Portugal.