Drs. M.M. Portegies, Historian
Over the period 1815-1857, Den Bosch experienced a rapid growth in its population. This resulted in poverty, leading to many inhabitants of the city having to live in wretched circumstances and various epidemics occurring.
The authorities were aware of the relation between poverty, bad living conditions and epidemics, and yet did next to nothing to improve the situation. Forceful intervention was not in keeping with the ruling views on man and society at that time. This view was encouraged, furthermore, through the workings of the human brain and through a lack of expertise.
Between 1815 and 1857 the population of the Netherlands grew by 1,058,000 people (47.4%) to a total of 3.3 million. We can compare this to the period 1961-2003, when the population grew by 40.7%, reaching a new total of 16.3 million. There does not seem to be a great difference between the degrees of population growth over the two periods. The effects of population growth, however, were completely different over the two periods. In the first half of the 19th century population growth caused a labour supply which structurally exceeded the demands of the labour market. As a result, the wages for unskilled labour inclined towards a level that was, just about, on the poverty line.1
In the second half of the 20th century, however, population growth did not create a structurally greater supply of employees. This was because young people were in compulsory education for a growing number of years and, therefore, not in employment. An additional factor was that virtually all elderly people received some form of pension instead of having to work themselves into the grave. Thirdly, the average number of hours worked per person has fallen by about 50%.
In order to get an idea of the effects of population growth on the general health of the population in the first half of the 19th century, we will take a closer look at the situation in the town of Den Bosch (also known as ‘s-Hertogenbosch) from 1815 to 1857.
Between 1841 and 1860, there was, on average, a significantly higher number of mortalities (not including stillborn infants) in Den Bosch than in most other towns and districts in the province of North Brabant. Only in Dinteloord and Willemstad were the average death rates higher.3
The fact that, in the Netherlands of the 19th century, high mortality rates were connected to geographically distinct areas, means that certain physical-geographical/physiographical and social factors particular to the regions must have played an important role. In the case of Den Bosch four of such factors were in play.
Firstly there is the dampness that characterizes the town. In wintertime, when the water level of the rivers rose, high water would often partly and sometimes wholly flood the town. This happened in 1816, 1818 and again in 1850. Additionally, many of the workers’ houses in den Bosch suffered from damp anyway. All this dampness caused malaria to be endemic in the capital of the province of North Brabant, while this was not the case in the vast majority of the province.3
A second factor which influenced the high mortality in Den Bosch was urbanization. In the first half of the 19th century the population of the Netherlands had a high rate of concentration in cities anyway. Over 37% of the population lived in places with more than 2,500 inhabitants. In Germany that figure was not quite 17%, and in France a little over 12%.4 With an average population of 19,607 over the 1827-1857 period, Den Bosch was by far the largest city of North Brabant. Tilburg came second, averaging a population of 13,379 souls. Contagious diseased can easily spread among densely concentrated populations. During the last and most severe smallpox epidemic of the 19th century, which took place between 1870 and 1873, the rate of deaths from smallpox was clearly highest in the towns, and in densely populated areas in general. 3
The household use of surface water from the river Dieze is the third factor driving up the mortality rate in Den Bosch. The household use of surface water is a common source of infections, such as cholera and other intestinal diseases. The development of the rate of mortality during different cholera epidemics in central Holland and West Utrecht in the 19th century shows us that the water used there for household purposes must indeed have been a continuous source of infections by intestinal diseases.3
The fourth cause of high mortality in Den Bosch was the extremely rapid population growth that took place.
Rapid Population Growth and Poverty
In the first half of the 19th century the population of the provincial capital grew even more rapidly than in other parts of the Netherlands. Between 1815 and 1857 the number of inhabitants increased by 8,567, i.e. 67.1%, to a total of 21,338 souls. 5
The effects this had on the average wage are not hard to guess. Generally speaking, the wages in Den Bosch did not rise above five guilders a week, while, at normal prices, a family with three children would need to spend three and a half guilders on potatoes and bread. That meant there was little left over to spend on rent or clothes. Even lower wages than these would have made life near to physically impossible for this large segment of the population.3
We need to take into account that poverty in Den Bosch increased from 1750 onwards and that about a third of the town’s inhabitants received poor around 1800. During the 1850s poverty had increased even more in Den Bosch. In those years around 60% of all the burials in the cathedral cemetery were paid for by the poor relief authorities.3 Things were not quite as bad in the rest of the country. On a national scale, the percentage of people receiving relief increased from 13 to 27 between 1841 and 18506
Because of the widespread state of poverty it was not just the members of Den Bosch’s underclass, but rather its average inhabitants who were living in overcrowded neighbourhoods, in cramped and damp housing. Many used water from the river Dieze, which runs through the city, as drinking water. This river also functioned as an open sewer and was used to get rid of detritus from the streets. The lack of sanitary facilities, such as clean water and a sewerage system, combined with the fact that people’s habits were not attuned to the importance of hygiene, meant that most inhabitants of Den Bosch lived under deplorable hygienic conditions. 3
Poverty and Epidemics
When a large part of the population is permanently destitute, and can therefore only meet such basic requirements of existence as food, clothing and housing in the most minimal way, then the state of their constitutions will be very vulnerable to infection and disease. 3 It is unsurprising that numerous epidemics broke out. In 1829, for instance, there was a measles epidemic among children. The year 1831 saw epidemics of smallpox and of malaria. In the following year the city’s inhabitants suffered from smallpox, malaria, cholera, laryngitis and diarrhoea. In 1833 204 people succumbed to a cholera epidemic which was still raging. In 1835 all of this was followed by scarlet fever, which resulted in many deaths. Apart from a bout of measles which killed a lot of children in the autumn of 1841, the city remained free of epidemics in the years leading up to 1846, when disease struck again. 3 This time it was typhoid fever, respiratory infections amongst children and whooping cough, amongst poor people in particular, which collectively took a heavy toll. In 1849 a cholera epidemic left 220 dead, which was over one percent of the population. In 1852 there was another smallpox epidemic and in 1855, finally, another epidemic of measles. 7
The Role of the Autorities
The city authorities were aware of the links between poverty, bad living conditions and epidemics. Still it continued to do next to nothing towards improving the situation. The reason that the magistrate did not decide to put structural measures in place, despite being privy to this insight, can be traced to two causes: firstly to current views on man and society, and secondly to certain general aspects of human psychology and neurology.
Where the first cause is concerned, we need to take into account the fact that societies contain rules for social conduct, and that social processes influence individuals. 8
In order to uncover people’s motivations, therefore, it is important to gain an insight into the current conceptions of man and society. In the 19th century the view was that a person’s circumstances in life were determined by the social position he or she was born into. Within Christian thought, this system of class relations was seen as natural and willed by God. This view of society was strengthened by the emerging science of economics, which was based on laws, which seemed to be similarly fixed and unchangeable. Ensuring individuals’ unlimited freedom of action was seen as the best way of achieving welfare for all. Poverty and unemployment were seen as unavoidable and temporary disruptions of the natural balance inherent in society and the economy. 3
The second explanation for the local authorities’ passivity in the face of poverty should be sought in the way the human brain functions. The psychologist P. Vroon connects this kind of attitude to the fact that the part of our brains that is responsible for our thinking, the neo-cortex, developed at an explosive rate over the last 100,000 years. This part has not been fully integrated into the rest of the system yet and does not have much control over the older parts, which are concerned with our motor, sensory and instinctive functions. 8
An important effect of this explosive growth of the neo-cortex is that, at a certain point in our history, a huge growth took place in such cultural phenomena as art and science. Our morals, however, do not reside exclusively in the newest part of our brains. Our intellect has developed at a much faster pace than our moral and emotional being. 8
Another effect of the lack influence of the neo-cortex over the other parts of the brain is that short-term thinking dominates long-term reasoning. As a result, gradual changes are not noticed until it is too late. When the problem does finally sink in, this by no means results automatically in a change of action. The reasoning part of our brain is often at the mercy of the more ancient parts, and the thoughts it produces are often not acted upon. 8
It is not just our individual actions that are partly controlled by mechanisms which are not in line with considerations of a moral and rational nature; this also applies to our social behaviour. Just as herd or pack animals have their leaders, who are followed even into death, we are strongly influenced by the existing division of roles and by authority. 8
Man is, furthermore, just as dependent on group cohesion as animals are. Within a social structure personal responsibility is generally subordinated to that of the group. The result is not only a “group feeling” and “shared responsibilities” but also a degree of individual obliviousness. Commands must be obeyed and other groups are no good, are the ruling thoughts according to Vroon. 8 in the opinion of the sociologist W.S.P. Fortuyn this phenomenon leads to inertia among the political establishment. A high degree of conformism and the effective exclusion of outsiders ensure that there is little room for new ideas and interests.9
The philosopher and economist N. Hertz argues that interest groups usually do not serve the general interest: “they follow their own agendas, but not the agenda of economically vulnerable minorities”. 10 The net effect is that society’s underside is usually the victim, as was the case in 19th century Den Bosch.
Against this background it is understandable that the city authorities did not take any structural measures, in order to attack the source of the unhealthy living conditions. Nor will it seem surprising, in this light, that Dutch local authorities in general had little concern for public health. The lack of expert knowledge on the subject, moreover, made it difficult to take effective measures. It was not until 1867 that the first lecturer on healthcare was appointed. 3
The fact that local authorities had to pay for measures concerning public healthcare out of their own funds, will only have strengthened their reservations about undertaking such actions. In most cases, the role of the authorities was confined to appointing “poor doctors” and midwives to provide some healthcare to the poor. It was only when contagious diseases threatened to become epidemic that the authorities in Den Bosch took some measures of a technical-hygienic nature.3
- Bie, R.J. van der and Smits, J.P. Eds.,
Tweehonderd jaar statistiek in tijdreeksten 1800-1999 [200 Years of Statistics in Timelines], Amsterdam 2001, pp 14, 16, 17. Internet : www.cbs.nl/nl/cijfers/kerncijfers/index.htm.< Mens en maatschappij. Bevolking. Maandcijfers. [Man and Society. Population. Monthly Figures.] Meere, J.M.M. de, Economische ontwikkeling en levensstandaard in Nederland gedurende de eerste helft van de 19e eeuw [Economic Development and Standard of Life in the Netherlands in the first half of the 19th Century], 's-Gravenhage 1982. (Cahiers Sociale Geschiedenis 1), pp 71, 74.
- Maddison, A., Ontwikkelingsfasen van het kapitalisme [The Developmental Stages of Capitalism], Utrecht and Antwerp 1982. (Aula paperback nr. 68), pp 75, 76.
- Portegies, M., Dood en begraven in 's-Hertogenbosch. Het Sint-Janskerkhof 1629-1858, (Death and Burial in Den Bosch: The Cemetery of the Sint-Jan Cathedral 1629-1858) Utrecht 1999. (Bouwhistorische en Archeologische Studies 's-Hertogenbosch, part 1), pp 156, 157, 159, 161, 162, 184.
- Kloek, J. and Mijnhardt, W., 1800. Blauwdrukken voor een samenleving (Blueprints for a Society), The Hague 2001. (Nederlandse cultuur in Europese context), p 38.
- Annual Report by the Municipal Authorities for 1857, Chapter 1. From the Municipal Archive in den Bosch (New Archive). p 2.
- Festen, H., 125 jaar geneeskunst en maatschappij [125 Years of Medicine and Society]. Geschiedenis van de Koninklijke Nederlandsche Maatschappij tot bevordering der Geneeskunst. Utrecht 1974, p. 26.
- Portegies, a.w., p. 151-153. Almanak voor de Provincie Noordbrabant, voor het jaar 1850 [Almanack for the Province of North Brabant, 1850], p. 84. Idem, for the year 1851, p 87.
- Vroon, P., Tranen van de krokodil. Over de te snelle evolutie van onze hersenen [Crocodile Tears: How Our Brains Evolved Too Quickly], Baarn 1989, pp 41, 65, 170, 245, 250, 251, 253.
- Fortuyn, P., “At your service”. The Last 32 columns, Hillegom, 2002, p 154.
- Anonymous, “You gotta go where the puck is”: Noreena Hertz and the Return of Public Service. News Report of the ASN Bank, nr. 4, February 2003, p 8, 9
Valkenswaard, May 2005