To assess the differences in the pattern of mortality by sex, age and cause of death between 1875-1879 and 1970 for the Netherlands, and the contribution of different causes of death to the decrease of total mortality between these periods.Mortality data for 1875-1879 were extracted from one of the first publications after the start of the national cause-of-death register, and were reclassified according to the cause-of-death classification in use in 1970. The mortality data for 1875-79 and 1970 were directly standardised using the age structure of the Dutch population in 1930.The mortality rates in 1970 were only a third (for men) to a quarter (for women) of those in 1875-79. Mortality patterns by age changed drastically, due to stronger mortality reductions among younger people. The share in total mortality decreased enormously for infectious diseases (from 38-39% to 4-5%) and for mental disorders/diseases of the nervous system (9-11% to 2-3%), but the shares of cancer (2-3% to 25-26%), cardiovascular diseases (7-8% to 42%) and external causes (1-3% to 7-9%) increased correspondingly. Almost 50% of the decrease of total mortality was due to a number of infectious diseases, of which respiratory diseases were the most important subgroup.The Dutch population experienced an 'epidemiological transition' very much like that described for some other countries.