In the long-running debate over standards of living during the Industrial Revolution, pessimists have identified deteriorating health conditions in towns as undermining the positive effects of rising real incomes on the ‘biological standard of living’. Here we review long-run historical relationships between urbanisation and epidemiological trends in England, and then address the specific question: did mortality rise especially in rapidly growing industrial and manufacturing towns in the period c.1830 – 1850? Using comparative data for British, European and American cities and selected rural populations we find good evidence for widespread increases in mortality in the second quarter of the nineteenth century. However this phenomenon was not confined to ‘new’ or industrial towns. Instead, mortality rose in the 1830s especially amongst young children (aged one to four years) in a wide range of populations and environments. This pattern of heightened mortality extended between c.1830 and c.1870, and coincided with a well-established rise and decline in scarlet fever virulence and mortality. Our evidence therefore supports claims that mortality worsened for young children in the middle decades of the nineteenth century, but also indicates that this phenomenon was more geographically ubiquitous, less severe, and less chronologically concentrated, than previously argued.