Abstract
This article investigates the emergence of Dutch preventive child health care in the first decades of the twentieth century. It shows that the rise of collective action on this terrain followed from the recognition of “infant mortality” as a public problem – a late–nineteenth century configuration that went hand in hand with the professionalisation of paediatrics. It also shows that the organisational forms that this collective action took depended on whose health was perceived to be at stake in specific articulations of the public problem of infant mortality. Finally, this article explores the motives of the Dutch state in the organisation of public health in the interbellum and queries the relationship between the state and public health more broadly. Drawing on pragmatist philosophy, we argue that states are best understood as the result of historically contingent processes that take on different forms in different times and places. Such histories enable a better view of the elements at play in the organisation of collective action and of the pivotal role played therein by the perception of public problems.
1 Introduction
“I visited the narrow alleys and bumpy roads in the capital of Limburg, just as well as the forested dune areas along Holland’s coasts and the heathlands on the Veluwe. Sometimes by foot. Sometimes by car. Always with another doctor or nurse at the wheel.”1 In the years leading up to the twenty-fifth anniversary of the Dutch League for the Protection of Infants in 1935, Nicolaas Knapper, a general practitioner and self-identified paediatrician from Amsterdam, travelled across the Netherlands to write a book about activities intended to fight infant mortality. He observed a patchwork of civil organisations and governmental bodies involved in child welfare and celebrated local collaborations between citizens, physicians, nurses, and public officials. Knapper was heartened by the fact that the problem was taken sufficiently seriously, that infant mortality was of national concern in the Netherlands. Nonetheless, “this social cause, which is already enjoying increasing interest from the people, will always feel the greatest need for strong, adequate support from the Government, for order from above!”2 Bustling local activities notwithstanding, Knapper seemed to suggest that the fight against infant mortality required top-down coordination. But if there had “always” been “the greatest need” for “order from above”, where had this order been up until 1935?
For scholars of public health, Knapper’s book is a wonderful historical source. Written in a lively manner and published with many photographs, it offers a colourful glimpse into the rise of preventive child health care in the Netherlands, a West-European country with a population of 5,104,137 in 1900, and 9,925,499 in 1950.3 While few measures had been taken in the Netherlands in the nineteenth century to prevent death and disease among the nation’s youngest, things changed in the early twentieth century. Whereas the passing of children had previously been accepted as a sad but inevitable fact of life, courses were now organised in cities and villages throughout the country that explained to new mothers how to properly nurse their babies. In almost every municipality, child health clinics sprang up. At these clinics, infants were routinely weighed and their mothers given nutritional advice. And district nurses began to cycle through neighbourhoods to conduct home visits.4 These activities were similar across local contexts. Moreover, they were collective in the sense that they were taken by groups of people with the same goal in mind: to prevent the death of children under the age of one. But, as is clear from Knapper’s book, they were also undertaken across the country without the involvement of the central Dutch government or some other sort of top-down coordination. How was this possible? Who were these individuals and collectives that independently began to organise preventive child health care in the Netherlands? And did they see themselves as contributing to the health of the Dutch nation, even if there was no central government driving their activities? What, in other words, does the rise of preventive child health care in the Netherlands tell us about the rise of public health in the absence of a centralised state?
Often, in literature about public health, the role of states is taken as a given. After all, the very word “public” seems to allude to defined political communities under the coordination and organisation of a central government. Yet, when we look at the historical emergence of public health activities, such a presumed state is often difficult to identify.5 In the Netherlands, certainly, public health was for a long time organised in the conspicuous absence of the national government. Instead, individual physicians and civil organisations took the lead. Sometimes they did so together with, or on instruction of, local governments. But nowhere did these activities come anywhere close to the workings of a centralised state.
In this article, we investigate this emergence of public health in the Netherlands “without the state”. We do so by tracing the emergence of Dutch preventive child health care. In 1901, the first child health clinic was established in The Hague, a city on the Dutch coast with then roughly 200,000 inhabitants. This clinic was a private initiative of the paediatrician Bernard Plantenga, who was worried about the many infants dying from poor nutrition in working-class neighbourhoods. Elsewhere, we discuss how Plantenga’s initiative became the dominant model in the first half of the twentieth century for the establishment of similar clinics throughout the country, including which effects this had on the spread of normative expectations about how mothers ought to behave.6 In this article, we first trace how infant deaths in the Netherlands became “a social cause” resulting in collective action in relation to the health of the nation’s infants.
In tracing this history, we aim to make three interrelated points. First, that the rise of collective action followed from the recognition of “infant mortality” as a public problem – a late–nineteenth century configuration that went hand in hand with the professionalisation of paediatrics. Secondly, we argue that the organisational forms that this collective action took depended on whose health was perceived to be at stake in specific articulations of the public problem of infant mortality. Was it the health of poor working-class families dwelling in the cities, the health of all Dutch citizens, or rather the health of a specific substrate, i.e., large Catholic families mostly living in the rural south of the Netherlands? Thirdly, we situate the role of the state in the rise of preventive child health care in the Netherlands. As we will show, in the first three decades of the twentieth century, a patchwork of political communities laid the foundations for Dutch preventive child health care – all in the absence of a centralised state. Only in 1927 did the national government get involved structurally, and then only to coordinate and fund the many private initiatives that were already underway. We use this history to highlight the motives of the Dutch state in the organisation of public health in the interwar period and to investigate the relationship between states and public health more broadly.
By public health, we mean “collective action in relation to the health of populations”. We borrow this definition from historian Dorothy Porter, which is insightful for two reasons.7 First, the emphasis on action highlights public health as a collaborative activity and prevents a myopic focus on governmental agencies.8 We understand public health as being the outcome of individuals and organisations doing things together. Secondly, Porter’s emphasis on populations – rather than a single population – highlights how the form and scale of collaborative activities depend on who is included in various groupings of bodies. “The urban poor”, to make this concrete, is a different grouping than “folks living in rural areas” or “Dutch citizens”. Populations can overlap or complement each other. Their boundaries determine who is and who is not considered a target of public health activities. These boundaries are historically contingent.
What is less visible in Porter’s work is how precisely the identification of populations and collective action relate to one another. How, if at all, do collaborative activities organised under the umbrella of public health depend on the ways in which various groupings of bodies come to be recognised as needing public intervention? To understand how collectives can be propelled into action, even or especially in the absence of central coordination, we here draw on the pragmatist philosophy of John Dewey and his understanding of the formation of “public problems”.9 Issues become “public”, Dewey famously argues, if they are perceived as having consequences for those not directly involved. Only then will they contribute towards the mobilisation of a political community, prompted to take an interest in the challenges at hand and to claim ownership of the problem.10 Thus, while infant deaths in the nineteenth century had been a private tragedy for individual families, “infant mortality” became a public issue only when these deaths began to be perceived as pervasive among poor families in cities, thereby endangering the local economy. This example first shows that groupings of bodies take their lead from how public problems are understood: approaching infant mortality as an economic problem brought into view a population of poor workers living in Dutch cities. It also shows how this understanding may affect the way in which collective action comes to be organised: as we will detail in this article, the initial understanding of infant mortality as an urban problem had a unifying effect on local groups of physicians, politicians, and wealthy citizens and motivated them to start preventive child health care activities that were specifically directed at families living in the impoverished inner-city neighbourhoods.
To analyse the shifting ways in which infant mortality came to be perceived in this period as a public health problem and to understand what were the consequences of this for the formation of political communities engaged in collective action, we draw from publications in the Nederlandsch Tijdschrift voor Geneeskunde (established in 1856), newspapers, statistical publications, dissertations, propaganda material, parliamentary minutes, and archives of organisations concerned with child health. The historical account is roughly chronological and divided into three parts. First, we explain how infant mortality in the late nineteenth century first became a “public problem” (section 2). The dying of small children as such began to have consequences affecting more people than only the families privately affected. In section 3, we show how different articulations of this public problem resulted in a motley collection of organisations undertaking preventive child health care in the early twentieth century. Finally, in section 4, we detail how at the end of the 1920s, the Dutch national government became involved by beginning to structurally fund civil organisations under strict national conditions, signalling that the first step had been taken in the direction recommended by Nicolaas Knapper in 1935: that an issue increasingly recognised as a “social cause” required “order from above”. It was in this instance, we argue, that preventive child health care first became a part of the fledgling Dutch welfare state, decades later than the emergence of the first public health activities on this terrain.
2 Infant Mortality as a Public Problem
Recent studies estimate that, around the year 1850, the number of infants that did not see their first birthday was between one in four and one in five.11 From a present-day perspective, these numbers would constitute a public health crisis. But in the nineteenth-century Netherlands, the topic roused little public attention. Terms such as “zuigelingensterfte” (in English: “infant mortality”) and “kindersterfte” (in English: “child mortality”) were seldom used in newspapers (see Fig. 1). Nor was the frequent death of small children really a topic of discussion. This changed around 1900, when, in a relatively short period of time, newspapers en masse began to comment upon the unacceptable mortality rates of small children in the Netherlands, which they began to label as “infant mortality”. A concept seemed to have been born, with normative implications: the mass death of children under the age of one, a toll than had previously been looked upon as a sad inevitability, was now a crisis that demanded public action. How are we to explain this change?
Infant mortality as a demographic, and discursive object of study.12
Citation: European Journal for the History of Medicine and Health 81, 2 (2024) ; 10.1163/26667711-bja10039
It is tempting, at the outset, to locate the growth in public attention paid to infant mortality in the phenomenon itself: public interest grew because many babies were dying. But babies had always been dying. In fact, from roughly 1840 onwards, fewer babies died every year (see Fig. 1). Around 1920, when press attention to infant mortality peaked, Dutch infant deaths had dropped to one in ten, an historic low at that time. In this section, we explain how the growing attention followed from the birth of “infant mortality” as a concept; a process whereby infant mortality became a public problem with consequences affecting more people than those privately involved. We show that this conceptualisation emerged because of three developments that occurred in the intervening period since the mid-nineteenth century. These were the medicalisation of feeding newborns, the professionalisation of paediatrics, and the collection of statistics bringing into view a new kind of people: infants.
2.1 The Medicalisation of Feeding Newborns
Until the mid-nineteenth century, child deaths received little attention from medical authors in the Netherlands; references to the topic were limited to textbooks on child rearing, one of the few publications where child deaths were discussed. A telling example is Duties of the Mother, published in 1849. Originally written in German by Saxon court physician Friedrich von Ammon, this manual was translated into Dutch, edited, and distributed among the Amsterdam elite. The author wrote that it is “well known” that “most mortals sink into the grave” during the “epoch of juvenility”. Unfortunately, “no human carefulness or efforts, nor medical aid could avert” these “sad events”.13 Children dying was a tragic but inevitable part of everyday life.
These manuals did highlight the importance of recognising “unnatural” deaths. Mothers had to look for bodily signs ranging from fever, coughing or “anguished wailing”, and had to call upon a doctor if needed.14 Mostly, however, it was mothers who were responsible for preventing their children from dying. This theme was prominent in The Mental and Physical Development of the Child, written by the Amsterdam physician Gerrit Allebé. This book was one of the most popular Dutch child-rearing manuals of the nineteenth and early twentieth century.15 In its preface, Allebé vented his frustration with the general neglect of the “child” as a “whole and living unity”, in which physical and mental development according to its “natural path” as intended “by God’s Creation” was considered the core responsibility of motherhood.16 Women, after all, were gifted “great natural privileges” and had the “undisputed advantage of the heart: their feelings are more exquisite, their love more pure and intimate, and lives – in contrast to males – more for the other”. Assuming that “sacrifice is the highest to which mankind is capable”, these characteristics made the mother a perfect fit for caring for children and preventing an “untimely death”.17 Hence, mothers were responsible for a natural upbringing.
Breastfeeding played a central role in this. In Duties of the Mother, Von Ammon stated that the “equal nature of mother and infant, this secret but strong bond, connects the newborn child to the maternal breast”.18 In the mid-nineteenth century, Dutch medical authors considered breastfeeding a sacred duty. Hence, Allebé could explain child death as a consequence of the broken spiritual connection between mother and child due to “unnatural” feeding practices and irresponsible abstinence from breastfeeding.
From around 1860 onwards, such perceptions gradually started to change in the Netherlands, albeit slowly and in stages. First, Dutch physicians became interested in abstinence from breastfeeding, and in improper nutrition more generally, as preventable causes of childhood disease and death. The Nederlandsch Tijdschrift voor Geneeskunde, founded in 1856 to foster professionalisation among the Dutch “medical class”, became the critical outlet to discuss this topic.19 Dutch medical authors were influenced by international debates. In particular the work of the Paris doctor Bouchaud at the Hospital de Maternité was the subject of extensive discussions. In an article published in 1865, Amsterdam hygienist Samuel Senior Coronol discussed how Bouchaud had shown the relation between nutrition and weight, and how the causes of “decay” in terms of losing weight were caused by improper feeding practices.20 A year later, Coronel elaborated on these interpretations in an article about “the death of newborns resulting from exhaustion and malnutrition”. He highlighted how feeding by the bottle instead of the breast explained sudden weight loss and death.21 Other medical authors began to focus on what was wrong with “feeding by bottle”. A chemical analysis of the superiority of “natural nutrition” over “artificial nutrition” was a popular way to approach this issue. From the 1870s onwards, Dutch physicians published enthusiastically about attempts – primarily undertaken in Germany – to find alternatives for breastfeeding; these ranged from condensed cow’s milk22 and buttermilk23 to fabricated cream.24 The challenge was to find nutrition with a chemical composition similar to breast milk. One explanation for the inferiority of feeding by bottle was the then-recent discovery of invisible causative agents or “germs” for infectious diseases and the spoilage of milk and wine. From a bacteriological point of view, infant disease and death were caused by unhygienic feeding devices or by the contamination of the artificial nutritional product itself.25
These new scientific insights contributed to the idea that with the proper feeding practices, child health was something that physicians could do something about. With that, the topic was medicalised and began to fall under the jurisdiction of medical expertise. In the 1880s and 1890s, many physicians published in the Nederlandsch Tijdschrift voor Geneeskunde on the subject of bacteriological assessments of cow’s milk and the need for the medical inspection of farms and the supply chain of milk in cities. In urban municipalities, local health committees started to inspect the “hygienic conditions” of infant milk supply.26 Those unable to afford “model milk” or provide natural nutrition were advised to feed their children homemade buttermilk.27 Or they could sterilise cow’s milk at home with the newly developed “Soxhlet” apparatus.28
2.2 The Concomitant Birth of Paediatrics and “Infants”
Towards the end of the nineteenth century, this emergence of “child health” as a medical object of concern was key in forming a collective of Dutch general practitioners worried about child death, breastfeeding, and artificial nutrition. In 1892, this group of nineteen physicians founded the “Nederlandsche Vereeniging voor Paediatrie”.29 This organisation became a central place for debates about the health of children. In the early years, minutes of annual meetings were published in the Nederlandsch Tijdschrift voor Geneeskunde. These reveal how Dutch physicians, towards the turn of the century, came to see malnutrition as the leading cause of infant disease and death.30 This mobilised both medical expertise and maternity services into efforts to do something about the deaths of small children; deaths that were now considered “unnatural” and “preventable”.
This professional development was aided by the increasingly specific collection of mortality data towards the end of the nineteenth century. Mortality rates had first become popular among Dutch hygienists in the mid-nineteenth century. As shown by Eddy Houwaart, the Dutch sanitary movement began to strategically employ statistics in this period to reveal the influence of miasmatic bad air in specific urban areas as the explanation for epidemics. These medical reformers “used pages of tables and maps to make a whole ‘new world’ intelligible that nobody had seen before”.31 Dutch hygienists were also a driving force behind the organisation of the Dutch medical profession in the middle of the nineteenth century. In this context, Abraham Hartog Israëls, one of the leading Dutch sanitary reformers, filled the pages of the Nederlandsch Tijdschrift voor Geneeskunde with annual mortality rates – primarily from Amsterdam.
Israëls and his colleagues initially focused on general mortality rates.32 After a few years, they also started to include age categories. In 1862, Israëls was the first to publish statistics on “child mortality”, with data of the mortality of Amsterdam children below the age of one, two, and three (see Fig. 2).33 These publications were not accompanied by substantive analyses. Inspired by German efforts to investigate the relationship between mortality and the quality, height, and fertility of soil in city areas, Dutch hygienists were primarily interested in the spatial relationship between death and neighbourhoods.34 While bacteriological explanations saw a waning of the interest in this spatial dimension, Dutch hygienists persisted in gathering mortality statistics that distinguished between age categories. These categories were used flexibly and there was no notion of “infants” as a specific group needing separate attention.
Excerpt from an early table that included age categories to compare mortality rates in various Amsterdam neighbourhoods.
Citation: European Journal for the History of Medicine and Health 81, 2 (2024) ; 10.1163/26667711-bja10039
source: abraham hartog israëls, “de sterfte der kinderen in de drie eersten jaren des levens te amsterdam, in de jaren 1850–1859,” nederlandsch tijdschrift voor geneeskunde (1862), 302.This changed in the late nineteenth century when the Nederlandsch Tijdschrift voor Geneeskunde started to publish more and more reports that specifically focused on the correlation between the mortality of children under the age of one and artificial feeding practices. First, these reports came from abroad, predominantly from Germany and France. A brief article from 1893, for example, highlighted how of the 12,294 children born in 1881 in Berlin, only 1,501 were fed “solely by maternal milk, 319 also received cow’s milk, 8,609 received solely cow’s milk, 762 received fabricated products. For the remaining 1,733 children, the nutritional source was unknown”.35 Together with chemical and bacteriological explanations of why artificial nutrition increased the chances of death on an individual level, the population-level correlation between child mortality and the absence of breastfeeding replaced spiritual explanations for why artificial nutrition resulted in the death of children. Thus, when a new Dutch manual for child rearing was published in 1889, it was no longer organised around the theme of how to raise individual children, but around causes of “child mortality” – of which artificial nutrition was the most prominent.36
Around 1900, these three developments – the medicalisation of feeding newborns, the professionalisation of paediatrics, and the collection of mortality data – brought a special kind of children into view: infants. Although many Dutch authors continued to mix “child mortality” and “infant mortality” well into the twentieth century, those who purposefully used the latter concept did so for a clear reason. In 1896, Parisian doctors and academics had started to discuss French mortality rates in the Parisian “Académie Nationale de Médicine” on the initiative of anthropologist and physician Gustave Lagneau. Lagneau compared the mortality rates of the general population against those for children specifically under the age of one; this was the age, after all, at which children “suckled” milk from their mother’s breasts (the Dutch word “zuigeling” means literally “suckler”). According to a reflection in the Nederlandsch Tijdschrift voor Geneeskunde, the Académie concluded that about one in six French deaths occurred in this age category, the so-called “mortalité de la première enfance”.37 In 1899, the Dutch state inspectorate on public health drew a similar conclusion: “In the Netherlands, according to reported life tables (and without stillborns taken into account), 24,252 children died at the age of less than one year in that year, which is 27.7% of the total mortality in the country.”38 According to Dutch statistician K.H. Rombouts, these newly collected mortality rates revealed “great sacrifices that are demanded by death under the age of one year”.39 Around the same time, Dutch paediatricians also discovered the particularity of this age group. In 1902, they discussed the issue intensively at the annual meeting of the Nederlandsche Vereeniging voor Paediatrie. Participants recognised the “sad and telling place” that infant mortality had taken in “general mortality rates. […] In the Netherlands, social and hygienic developmental conditions leave much to be desired.” Chairman Denekamp wondered rhetorically what might possibly explain these mortality rates. The answer was obvious: “The lack of the mother’s breast should undoubtedly be considered a main cause of high infant mortality.”40
Hence, around the turn of the twentieth century, Dutch medical authors began to see “infants” as a specific kind of people based on how they ought to be fed. Consequently, “child mortality” and “infant mortality” came to be seen as related problems but as different still. The former referred to death at a young age, the latter to death at an age when children still ought to suckle. This, in turn, increased attention on the question of why some mothers did not breastfeed; or more specifically, on the question of which groups of mothers failed to nurture their infants adequately.
As baby deaths were now conceptualised as infant mortality, the phenomenon turned into a public issue. For while the death of individual infants had earlier been thought of as private tragedies, the threatened health of an entire population – i.e., infants – now came to be seen as consequential for many more people than only those families directly affected. David Armstrong has observed a similar conceptual transformation in Great Britain around this time: “Until the end of the 19th-century infant mortality was a problem of the biological realm […]. In the early 20th century, it became a problem of society.”41 In the Netherlands, indeed the birth of “infant mortality” united a heterogenous group of general practitioners, hygienists, paediatricians, and statisticians around a shared concern. Decreasing infant mortality became their common interest. And with that, the levels of public attention paid to “infant mortality” soared in newspapers and other outlets – decades after infant mortality rates had started to fall in the Netherlands.
3 Collective Action without the State
Around 1900, as we have described, “infant mortality” became a public issue in the sense that its consequences were perceived to reach beyond those privately involved. What these consequences precisely were, however, shifted in the first decades of the twentieth century and brought different political communities into being, ranging from wealthy citizens aiming to “elevate” the working class, to clerical leaders worried about the prosperity of Catholics in the Dutch south. In this section, we show how this dynamic gave rise to a motley collection of organisations undertaking Dutch preventive child health care in the early twentieth century – all without coordination from a centralised state.
3.1 Infant Mortality as a Socioeconomic Issue
Pioneering efforts to reduce rates of infant mortality were first undertaken in Dutch cities around 1900. These early forms of collective action were driven by the perception of infant mortality as a socioeconomic problem. Medical authors identified socioeconomic problems as one reason why breastfeeding was avoided. Amsterdam physician Stephan stressed that “especially the less-fortunate classes refrain for social reasons”.42 Influenced by discussions in Belgium and France, authors specified this group as the “working class” who could not afford medical aid and refrained from providing “natural milk”, instead feeding their infants with unhygienic and indigestible artificial alternatives.43 Infant mortality was perceived to be a class problem.
E. J. Jonkers, a physician from Groningen, was one of the first to publish a book exploring the connections between infant mortality and the “lower class” (in Dutch: “volksklasse”).44 “The level of development and civilisation of the parents,” Jonkers argued, “also greatly influences infant mortality: the more developed they are, the lower the infant mortality rate is”.45 This degree of civilisation referred specifically to housing conditions, family size, and a lack of knowledge or education. Based on his experiences as a general practitioner, Jonkers dismissed the idea that it was the unhealthy environment of “shanties” and “basements” in which poor families lived that caused the apparent increase in the numbers of deaths in large families. Instead, he was worried about how working-class mothers preferred nutritional advice from neighbours over professional medical advice.46 A 1904 medical textbook on infant nutrition further elaborated on the specific characteristics of these families: they lived in big cities, had children without being married, had many more children than could be supported, and worked in factories.47
Jonkers stressed that these poor families should not be blamed. The root cause lay “in the social imbalances, resulting from death from hardship and poverty, and industrial crises due to overproduction”.48 Working hours were a concrete example of the practical dimension of the relationship between working-class families and artificial nutrition. An increasing number of politicians and medical authors realised that many mothers were practically unable to breastfeed because they had to work in factories. As most of these mothers did not live close to their work, physically feeding their children was practically impossible.49 Various creative solutions were discussed in the early twentieth century. In 1902, the national Social Democratic Labour Party investigated the option of day-care centres next to factories.50 And in 1908, the Dutch Female Social Democratic League organised a national conference to debate paid pregnancy leave to give mothers time to breastfeed.51
Seeing infant mortality as a socioeconomic problem fitted a broader fascination among urban social-liberal elites for sociocultural progress that could be stimulated by emancipating the lower classes in cities. Attempts by civil reformers (in Dutch historiography known as “volksverheffers”) to improve the living conditions and physical and mental health of lower-class citizens in Dutch cities between 1870 and 1914 have been investigated by Dutch historian Christianne Smit, who shows how the socioeconomic reformative projects often blurred the boundaries between medical and civil reform.52
This dimension also fitted early–twentieth century ideas about the economic importance of labour capital. Groningen general practitioner Gerard Scheltema, later celebrated as a pioneer of Dutch paediatrics,53 was an outspoken voice in this regard. At a 1902 meeting of the Nederlandsche Vereeniging voor Kindergeneeskunde, he stressed the societal loss of manpower because dead infants would never develop into strong workers.54 In 1912, Scheltema developed these ideas into a booklet that health reformers later referred to as the foundational text justifying preventive child health interventions, titled Kinderbescherming als Eisch der Maatschappij.55 According to Scheltema, “Paediatricians and hygienists practice the medicine of poverty.”56 They did so to “prevent suffering for the sake of children themselves”, but also because a society that did not combat infant mortality “grossly harms itself by passively watching its young elements being eroded in their physical and work capacity by removable causes, thus making them more invalid than the nature of things demands, and therefore liable to excuse”.57
As the socioeconomic dimension of infant mortality received more acceptance, Dutch medical authors began to argue that the mass death of newborns could not be solved by doctors alone. At the beginning of the twentieth century, therefore, paediatricians, hygienists, and statisticians started to form alliances with civil reformers such as feminists, urban “volksverheffers”, and progressive local politicians into a political community of socio-medical reformers. Inspired by French examples, from 1901 onwards, these reformers started to organise visiting hours in the clinics of enthusiastic general practitioners. Here, nutritional advice was combined with the supply of sterilised cow’s milk. Crucially, those first child health clinics were explicitly targeted at the poor (in Dutch: “armenpraxis”) in larger cities, such as The Hague, Amsterdam, Haarlem, Rotterdam, and Utrecht. They were initiated by local charitable associations, often in collaboration with the municipal governments of these urban areas.58
3.2 Infant Mortality as a Nationalistic Issue
In the nineteenth century, Dutch reports on child mortality focused primarily on cities or municipalities. This was the case for practical reasons. Mortality rates were mainly collected by municipal health committees, which were legally obliged to advise local councils on public health. There was simply no agency for the collection of statistics for the entire country. This changed, however, when statisticians started to combine local statistical reports to gain insights into national mortality rates.59 A key figure in this effort was Rudolph Hendrik Saltet. Saltet was the first director of the Amsterdam Municipal Health Service in 1891 and later worked as a state inspector for public health. In these positions, he focused on eradicating epidemics. Appointed professor of social medicine in 1896, Saltet then started to supervise projects on infant mortality. These efforts added a geographical dimension to the understanding of Dutch infant mortality (see Fig. 3).60
Example of one of the first comparative tables based on population statistics published in the Netherlands.
Citation: European Journal for the History of Medicine and Health 81, 2 (2024) ; 10.1163/26667711-bja10039
source: r. h. saltet and gemeente amsterdam. bureau van statistiek, kindersterfte in nederland (in de jaren 1881–1905) (amsterdam, 1907), 2.The Nederlandsch Tijdschrift voor Geneeskunde had already begun, in the second half of the nineteenth century, to publish the mortality statistics of other countries. This was primarily in the context of laudatory discussions of governmental interventions intended to improve feeding practices in France and Germany.61 Early–twentieth century studies, however, started to rank multiple countries on their mortality rates and other population characteristics. Alison Bashford and Mark Soloway explain this attention to quantitative demographical aspects in the context of growing international tensions between nation states in the early twentieth century.62 In the Netherlands, nationalistic sentiments were indeed a potent ingredient in the growing interest in infant mortality and national demography. Saltet himself, for example, highlighted how infant mortality had a negative effect on population development. He worried that, “in the battle of nations”, this stagnation would be a “huge danger”, eventually “leading to defeat”. He was convinced that this looming emergency was the main reason why most medical authors had “discovered this population question” and “published about the topic in the Nederlandsch Tijdschrift voor Geneeskunde”.63 Likewise, Herman Sterneberg, a physician-turned-statistician who researched infant mortality under the supervision of Saltet, concluded his dissertation with the motto “through the child for the nation”.64 According to Sterneberg, the prevention of infant mortality could not be left to civil society; municipal and national governments had to provide structural funding.65 Sterneberg thereby expanded the socioeconomic understanding of infant mortality into a national one. Reducing infant mortality, he stated, “was of the utmost importance to the State from an economic point of view, and to the Nation in view of its survival”.66
The nationalistic dimension of infant mortality gained further momentum with the 1906 appointment as director of the Dutch central bureau of statistics of Henri Methorst, who envisioned demographic statistics as the foundation for thinking about “the survival of an entire nation, and a whole race”.67 In 1916, he published a lengthy article on birth decline and infant protection in the Nederlandsch Tijdschrift voor Geneeskunde. Many socio-medical reformers later remembered this publication as pivotal in fostering a sense of urgency in the Netherlands that action must be taken to reduce the rate of infant mortality.68 Methorst signalled that low Dutch fertility rates represented a danger for the size of the Dutch population, but argued that it was very difficult to do something about this.69 Population decline could be arrested instead by shifting the focus to efforts made to reduce mortality, especially infant mortality.70
Methorst proclaimed the need for a “central body” taking up the “interest of our [Dutch] national strength” by steering collaboration between organisations that were already active in setting up child health clinics, organising maternity courses, and spreading propaganda about infant care. At stake was the health of “Dutch people as a whole”.71 Such nationalistic ambitions, however, stood in sharp contrast with the local nature of collective activities that had recently been set up to combat infant deaths among the poor. The socioeconomic dimension of infant mortality had led to the establishment of infant clinics and milk kitchens in cities on a relatively modest scale. In a bid to achieve national coordination, paediatrician Jan Graanboom, who founded the first Amsterdam infant clinic in 1901, proposed the creation of a national Dutch organisation.72 On 10 April 1908, many pioneering Dutch professors of obstetrics and paediatrics participated in a meeting at the Amsterdam city hall, that resulted in the establishment of the Nederlandsche Bond tot Berscherming van Zuigelingen.73 The newly founded league first aimed to “foster legislation with respect to child welfare” and “foster the foundation of infant clinics”, in addition to facilitating “data collection on local infant mortality rates” and “propaganda on hygiene improvements for pregnant mothers”.74 This shows how the league was initially designed both as a space for exchanging knowledge and as a lobby group for progressive legislation to enforce child welfare on a national level.
This ambition turned out to be too far-reaching, however. As the years progressed, members began to see its strategic focus as ineffective. In a meeting in 1913, the board even discussed liquidating the league because of how little had been seen to be achieved.75 In the end, however, it decided to shift focus and change the organisation’s statutory goals. As of 1914, the League would focus on fostering collaboration between pre-existing local organisations.76 Still, it continued to publish a series of propagandistic brochures with elaborate demographic statistics on national mortality rates. Building on the conceptualisation of infant mortality as a threat to national strength in “a battle of nations”,77 the League in 1915 published its first booklet, titled Beschamende Zuigelingensterfte. Made visible by demographic statistics, infant mortality had become something of which a nation might expect to be ashamed.
3.3 Infant Mortality as a Regional Issue
Beschamende zuigelingensterfte served to sound the alarm about Dutch infant mortality rates that the League considered to be shameful. To do so, the booklet was filled with pages of tables listing infant mortality rates in almost every Dutch municipality, which were then put together in a complete map of the Netherlands. Beschamende zuigelingensterfte was first published during the First World War, at the height of the battle of nations. While its goal was to elicit national action, one consequence of the mapping of infant mortality in this way was that differences between regions came into view. On the Dutch map, municipalities with higher mortality rates were coloured in in progressively darker shades (see Fig. 4). This was a deliberate strategy on the part of the authors: they hoped that, by convincing readers of the necessity for “new investigations” into these “darkened places”, they could thereby contribute to a reduction in the infant mortality rate in the country overall.78
Seeing infant mortality as a regional problem through coloured maps.
Citation: European Journal for the History of Medicine and Health 81, 2 (2024) ; 10.1163/26667711-bja10039
source: nederlandsche bond tot bescherming van zuigelingen, beschamende zuigelingensterfte (amsterdam, 1915), 15.What it achieved in the short term, however, was to make clear that the Southern provinces of Zeeland, Noord-Brabant, and Limburg had significantly higher infant mortality rates (respectively 12.2, 15.8, and 15.9 per cent) than the national average (10.4 per cent). It also showed that mortality was extraordinarily high in small municipalities such as Gemert, Prinsenhage, Witten, and Vaals. In effect, it transformed the understanding of the nature of the infant mortality problem in the Netherlands. No longer was it seen as a public problem that especially overcrowded cities had to deal with. Instead, the countryside required immediate attention.
In 1920, the League published Nog Altijd Beschamende Zuigelingensterfte (“Still Shameful Infant Mortality”). The publication contained an updated representation of geographical mortality statistics. With it, the authors intended “to stimulate more inquiries aiming at explaining local mortality rates and to initiate local activities to reduce its number”.79 The booklet revealed that “the countryside, specifically the south, lags behind in taking those measures that have resulted in the successful reduction of infant mortality in cities”.80 Regional differences now explained national mortality rates. As Henri Methorst, director of the Dutch Bureau of Statistics, wrote in the Nederlandsch Tijdschrift voor Geneeskunde in 1920: “especially those who bear the responsibility for public health in the countryside should be ashamed”.81
In the 1920s, this regional dimension came to dominate Dutch debates about infant mortality. Local spaces were no longer discussed as independent entities; they made up the greater whole of the nation, with the rural regions in the south obviously weaker parts of a larger political body. Consequently, debates about Dutch infant mortality gravitated toward explanations of the particularities of the “rural south”, in contrast to the rest of the country.
3.4 Infant Mortality as a Catholic Issue
One important characteristic that set the rural south apart from the rest of the country, including other rural areas, was their religion. Whereas Protestantism was the dominant religion in the north and middle of the country, nearly all municipalities in the south consisted of Roman Catholic communities.82 This observation convinced Dutch socio-medical reformers that Catholicism encouraged habits that led to infant death.83 In 1915, for instance, the provincial government of Limburg issued an investigation into infant mortality after it learned that its mortality numbers “exceeded those of other provinces,” even rural ones, such as the Northern province of Friesland.84 In the resulting report, the blame was put on the Catholic norm for having as many children as possible. This urge to procreate resulted in high fertility rates among Catholics. But because of a general hesitancy to properly feed their children, many families could not keep all these newborns alive.85 Other socio-medical reformers argued that Catholics explained the death of children as “destiny” and saw their deceased newborns as “a pretty angel in heaven” that “will pray” for the family.86 The regional dimension of infant mortality thus came to be seen as a Catholic problem in the rural south.
This development led to introspection about the responsibilities of the church and its leadership in reducing infant mortality. Of particular importance was Cornelis Meuleman, a Catholic obstetrician who was one of the first board members of the Nederlandsche Bond tot Bescherming van Zuigelingen.87 Meuleman adopted a provocative style in addressing his colleagues in the newspaper De Katholiek. He fiercely refuted the fatalistic idea that infant death was a part of earthly life and he likened to abortion infant deaths resulting from a refusal to breastfeed or from unhygienic artificial nutrition.88 Employing moral-theological writings, Meuleman argued that breastfeeding was a moral obligation and artificial nutrition a “daily sin”.89 As such, he hoped to mobilise the Catholic church as an ally in the fight against infant mortality: “It is the responsibility of the pastor and confessor to encourage mothers to self-feed their children.”90 Meuleman addressed clerical leadership and highlighted that its influence could have a “decisive impact in the fight against infant mortality”. Thus, “while the clergy should recognise the need for breastfeeding, every organisation dedicated to fighting infant mortality should include clerical leadership in their activities”.91 Preventive child health care had to be carried out by a partnership of municipal governments and Catholic civil society.92
This call to arms fitted well with the early organisation of preventive child health care in the Dutch countryside. Whereas larger cities profited from professional municipal health services, health care in rural regions was much more limited and was in the hands of general practitioners and civil organisations that provided nursing, midwifery, and medical supplies on a charitable basis. “Cross associations” played a big role in rural health care. This had started in 1875 with the “White Cross,” that was founded as a peacetime alternative to the Red Cross and focused on the fight against infectious diseases, hygiene, and public health.93 In 1900, the “Green Cross” was founded, which focused on the charitable supply of home care.94 Between 1900 and 1909, 422 Green Cross departments were established across the Netherlands, of which only five were located in the southern and predominantly Catholic provinces of Limburg and North Brabant. This began to change in 1910, when Charles Ruijs de Beerenbrouck – who would later become the first Dutch Catholic prime minister – founded an explicitly Catholic provincial Green Cross department in Limburg that, when Clemens Meuleman became involved, also began to focus on child care and maternity care.95 Attempts to establish more Green Cross departments with a Catholic signature initially failed. But efforts to foster collaboration led in 1923 to the establishment of a White-Yellow Cross association under clerical leadership with their stated main goal being to: “foster public health, under which we mean the battle against infectious disease […] and against infant mortality”.96 In 1939, the White-Yellow Cross had 136 departments in Limburg, 168 in North Brabant, and 222 in the rest of the Netherlands.97
The foundation of the White-Yellow Cross marked a turning point in the engagement of Catholic leadership with the issue of infant mortality. Already in 1920, the Dutch League for the Protection of Infants had explicitly welcomed “Catholic associations in North Brabant and Limburg as allies in the battle against infant mortality.”98 Over the course of that decade, Catholic leadership in the Netherlands mobilised a political community of socio-medical reformers to organise preventive child health care in the Dutch south. These activities added another organisational ingredient into the mix of groups and individuals each now combatting infant mortality in the Netherlands. This motley collection gave rise to Dutch preventive child health care, but was essentially an uncoordinated patchwork with huge regional differences. Towards the end of the 1920s, this variety began to be considered undesirable, although not necessarily because it was unsuccessful in its original socio-medical goal: reducing infant mortality. This instead reflected a change of priorities whereby the organisation of public health had to be seen to serve an administrative goal: state formation.
4 Infant Mortality as a Matter of State
The Dutch national government did not consider infant mortality to be a problem in need of its interference until after the First World War. This should not be explained as indifference. In the early twentieth century, Dutch politicians still perceived the national government as just one cog in a public machine in which provinces and especially local municipalities functioned as important governmental bodies. These bodies worked alongside one another rather than in a hierarchical relationship intended to implement national policies. In what is usually referred to as the legislative “House of Thorbecke” – after the liberal legal scholar, prime minister, and author of the Dutch 1848 constitution – governmental primacy was to be found at the local level of the municipality, as close to individual citizens as possible.
This started to change in the interbellum. In this period, members of Dutch parliament began to reference the publications of the Dutch League for the Protection of Infants to argue that infant mortality did indeed constitute a national problem.99 Subsequent calls to arms convinced minister Hendrik Albert van IJsselsteyn that “still, many more children die than necessary” and that the domain of preventive child health care “is fallow land and requires cultivation”. While a state inspectorate was dedicated explicitly to “child hygiene” in 1919, this administrative agency was short-lived.100 In 1923, a new cabinet combined the new state inspectorate with that of infectious disease and cut funding for the Dutch League for the Protection of Infants.101 The priority was on getting government expenses under control and to reduce spending.102 Still, government and parliament agreed that the national government would get involved somehow. After all, “a weak people shall become a poor people”.103 By 1924, the point of the discussion was not if the national government should be active in preventive child health care – but how.
At first, the national government decided to focus on funding provincial departments of the White-Yellow Cross associations, especially in the southern province of Limburg.104 This made sense; as Suze Groeneweg, the first female representative, put it in 1922, “infant mortality is very high in Limburg, especially in comparison to other provinces, and a lot has to be done”. Limburg would thus receive 18,000 guilders, with the remaining 2,000 guilders of the state budget going to other regions.105 This led to criticism in Dutch parliament. Seeing infant mortality as a regional problem revealed regional differences, but did such a realisation also justify that Catholic White-Yellow Cross societies in the south received substantially more taxpayer money than secular Green Cross associations in the North and East of the Netherlands?106
Until the mid-1920s, this unequal distribution of funds remained a point of contention in Dutch parliament. Member of Parliament Albert van der Heide, for example, wondered in December 1926 why Northern Cross Societies received such a relatively small amount of funding. The Frisian Social Democrat admitted that Catholic regions struggled with “higher infant mortality rates”, and understood, therefore, that Catholic organisations, such as the Limburg Green Cross and White-Yellow Cross in North Brabant, would receive more funding. But that these two organisations received 15,000 and 7,000 guilders respectively, was “unfair and unjust” compared to the 180 guilders for the Green Cross associations from Groningen, Friesland, and Zeeland.107 In 1926, the newly appointed minister of labour, trade and industry Jan Slotemaker de Bruine convinced his fellow cabinet members that a budget increase to 63,000 guilders was needed to improve child welfare “across the entire country”. This would also give him “the opportunity to design a new system” for funding Cross associations more fairly and transparently.108
The intention to design a mechanism in which funding for child welfare was “systematically” distributed sounds unspectacularly bureaucratic. Nevertheless, the specific way in which that system was set up led to the definitive organisational involvement of the national government in child welfare. From 1927, it aimed to integrate diverse local forms of child health care and took up a coordinating role on a national level. It was this administrative step that made the Dutch state structurally involved in organised activities intended to protect the health of infants.
In practice, this took the following form. Provincial departments of White, White-Yellow, and Green Cross societies were trusted to run child welfare. If more Cross associations existed in one province, they had to form a committee in which they collaborated.109 These provincial “districts” had to hire a “district paediatrician” to provide medical consultation for mothers in pre-established child health clinics and to establish new clinics in municipalities where these did not exist. In 1932, 198 child health clinics were led by a professional paediatrician and 183 by a general practitioner.110 Besides a paediatrician, provincial districts also had to recruit a “district child nurse” responsible for home visits, maternity courses, educating fellow district nurses, and administering child health clinics. On paper, the provincial districts had to pay all the bills. Yet, the national government provided funding for two-thirds of the paediatrician’s salary, of the personal expenses of the district nurse, and of the travel costs, and one-third of the health insurance fees of the district nurse. On top of these personnel costs, the national government funded provincial districts with two-thirds of the administrative costs for child health care activities.111
This organisational scheme, intended to integrate and enforce pre-existing collective action, wove organised preventive child health care into the Dutch state. It incentivised local civic organisations to collaborate on a regional level and to work closely with socio-medical reformers (general practitioners, paediatricians, and local officials) who had established child health clinics and organised maternity courses from the beginning of the twentieth century. The national government provided financial aid and coordination through funding requirements. By 1932, the Netherlands was covered by a patchwork of child health clinics partially funded by the government and organised by a variety of local and regional organisations (see Fig. 5). The role played by the national government in 1927 should not, therefore, be understood as a break from state abstinence. By attempts to avoid “unfair” regional diversity, civil society and local, regional, and national governments were instead deliberately made interdependent when undertaking public health as collective action in relation to the health of populations. Local activities were integrated into a Dutch system. The participation of the Dutch state in preventive child health care thus strengthened the association between local voluntary efforts and governments that would characterise the Dutch “welfare state” until well into the twentieth century.
This map shows the locations of child health clinics in 1932. The size of icons reflects the number of child health clinics in that particular town or city, with larger icons representing greater numbers of clinics.
Citation: European Journal for the History of Medicine and Health 81, 2 (2024) ; 10.1163/26667711-bja10039
5 Conclusion
In 1927, the year that the Dutch national government first got involved in the organisation of preventive child health care, pragmatist philosopher John Dewey published The Public and Its Problems, in which he explores how states emerge in relation to the notion of the “public”. In contrast to political philosophers who develop abstract theoretical notions of “the State”, Dewey proposes a “consistently empirical or historical treatment of the changes in political forms and arrangements, free from any overriding conceptual domination such as is inevitable when a ‘true’ state is postulated, whether that be thought of as deliberately made or as evolving by its own inner law”.112 States, in other words, are no fixed entities that can be discovered a priori. Instead, they are the result of historically contingent processes and take on different forms in different times and places. Hence, if one wants to analyse the role of the state in relation to public health, it is worthwhile to examine how that state historically came into being – to gain a better view of the elements at play in the organisation of collective action and of the pivotal role played therein by the perception of public problems.
In Dewey’s analysis, an issue becomes public as a result of “the perception of consequences which are projected in important ways beyond the persons and associations directly concerned in them”.113 In the Netherlands, this process took place towards the end of the nineteenth century, when the deaths of small children came to be understood as “infant mortality”, a public issue that was considered unacceptable. The emergence of this concept had two distinctive features. First, infants – perhaps better referred to in this context as “sucklings” – came to be understood as a separate kind of people: tiny individuals under the age of one year, individuals who ought to be breastfed.114 Secondly, “infants” came to be understood as a population: a group of bodies that had to be cared for collectively, because the death rates within this group came to be considered harmful for more people than just those directly affected by their passing. Failing to breastfeed infants thus came to be identified as a public problem which warranted collective action.
Still, “infant mortality” was perceived in multiple ways in the Netherlands in the early twentieth century. Initially, it was considered particularly prevalent among working-class families, which thereby imperilled the “labour potential” of Dutch cities. Then, with the advent of the Great War, nationalist authors began to use infant mortality as a proxy indicator for “national strength”. This led to the moulding of infant mortality as a regional issue, as the collection of statistics began to show that most of the infants who were dying in the Netherlands had lived out their brief lives in the rural south. Finally, this led to an understanding of infant mortality as a Catholic issue, as this was the predominant religion in the Dutch rural south. These shifting discursive understandings were of formative influence on the way in which collective action came to be organised in the Netherlands. Each understanding brought different political communities into being: collectives, as Dewey would have it, that “are affected by the indirect consequences of transactions to such an extent that it is deemed necessary to have those consequences systematically cared for”.115 Thus, in the first decade of the twentieth century, a political community of urban social liberals took the lead in organising preventive child health care in The Hague, Rotterdam, Utrecht, and Amsterdam. Then, in the 1910s, a political community of nationalist health reformers tried to establish a nationwide system for combatting infant mortality. And finally, in the 1920s, a political community of religiously inspired health reformers began to organise preventive child health care activities in rural areas of the Catholic south.
In 1927, the Dutch national government began to coordinate and structurally fund these pre-existing collective actions. Their involvement had two consequences. On the one hand, it resulted in the national integration and expansion of Dutch preventive child health care over the course of the 1930s. What had been a mixture of collective actions was gradually moulded into a fairly uniform set of collective practices in the form of weighing babies, educating mothers, and visiting families.116 On the other hand, it strengthened the Dutch model of a welfare state wherein the national government mostly funds and coordinates activities that are initiated and organised locally by a conglomerate of civil and professional groups. According to Dewey, a “state” is “the organisation of the public effected through officials for the protection of the interests shared by its members”.117 With the involvement of the Dutch national government, public officials indeed began to play a role in the organisation of preventive child health care. What their role looked like precisely followed from the way in which collective action on this terrain had taken shape in the foregoing decades, which in turn followed from the shifting ways in which infant mortality had come to be perceived as a public problem. Hence, we propose that the historically specific shape of states can effectively be understood as a consequence of public health, instead of as its starting point. This shape follows from (a) the shifting ways in which issues are perceived as public problems, and from (b) the political communities that organise themselves in reaction to these problems. In figuring out why and how collectives undertake public action, the historical trajectory of the perception of a phenomenon deserves as much attention as the phenomenon itself.
Acknowledgements
We would like to thank Ralf Futselaar and Timo Bolt for their feedback on earlier versions of this article, and Mayra Murkens for pointing us to recent scholarship on the historical demography of the Netherlands. We are also grateful to Bram van der Graaf for providing access to his digitally constructed map of the Netherlands, which we used to construct Figure 5 in qgis.
Nicolaas C.F. Knapper, Een kwart eeuw zuigelingenzorg in Nederland (Amsterdam, 1935), ix.
Ibid., 27. Italics in the original.
Theo Engelen, “Van 2 Naar 16 Miljoen Mensen,” Demografie van Nederland, 1800-Nu (2009), 13.
The rise of these preventive practices is discussed in Martijn van der Meer, Florian R. R. van der Zee and Noortje Jacobs, “A Good Mother Enters the Clinic: How a Medical Institution Became an Agent of Socialization, 1900–1940,” (unpublished manuscript).
Angus Dawson and Marcel F. Verweij, eds., Ethics, Prevention, and Public Health, Issues in Biomedical Ethics (Oxford–New York, 2009), 26.
Van der Meer, Van der Zee and Jacobs, “A Good Mother Enters the Clinic”.
Dorothy Porter, “The History of Public Health: Current Themes and Approaches,” Hygiea Internationalis, 1 (1999), 11.
A focus on non-governmental actors is a fruitful way to explore public health efforts undertaken by religious and humanitarian organisations; see, for example, Jonathan Barry and Colin Jones, Medicine and Charity before the Welfare State, Studies in the Social History of Medicine (London, 1991).
John Dewey, The Public and Its Problems: An Essay in Political Inquiry, ed. and intr. Melvin L. Rogers (University Park, PA, 2012).
Ibid.; Noortje Marres, “Issues Spark a Public into Being: A Key but Often Forgotten Point of the Lippmann-Dewey Debate,” in Making Things Public: Atmospheres of Democracy, ed. Bruno Latour and Peter Weibel (Cambridge, MA, 2005), 208–217; Craig Calhoun, “2 Facets of the Public Sphere: Dewey, Arendt, Habermas,” in Institutional Change in the Public Sphere: Views on the Nordic Model, ed. Fredrik Engelstad, Håkon Larsen, Jon Rogstad and Kari Steen-Johnsen (Warsaw, 2017), 23–45.
Pieter E. Treffers, “Zuigelingensterfte en geboorten in de 19e en begin 20e eeuw,” Nederlandsch Tijdschrift voor Geneeskunde [hereafter: ntg] 152 (2008): 2789; Evelien C. Walhout, “An Infants’ Graveyard?: Region, Religion, and Infant Mortality in North Brabant, 1840–1940” (PhD thesis, Tilburg University, 2019), 51.
The demographic information for making the black graph is based on Peter Ekamper and Frans van Poppel, “Zuigelingensterfte per Gemeente in Nederland, 1841–1939,” Bevolkingstrends, 1 (2008), 24. The grey N-gram graph is based on the Dutch newspaper database curated by the Dutch Royal Library and searchable through the “Delpher” portal (accessible through <www.delpher.nl>). We counted the number of articles containing the keyword “zuigelingensterfte” or the keyword “kindersterfte” (15,718) and recalculated this number as a percentage of the total amount of newspaper articles in that given year. As some years contained a larger total number of articles than others, these percentages provide a more precise indication of the growing attention paid to infant mortality in newspapers than the absolute number of articles would.
F. A. von Ammon, De pligten der moeder, in betrekking tot de allereerste ligchamelijke en geestelijke vorming van het kind (Amsterdam, 1849), 264.
Ibid., 266–267.
The book was reprinted over eight times and edited by many prominent Dutch physicians. Ph. Kooperberg attributes the popularity of the book to its “friendly tone of voice”, while G.A. Ootmar explains its “monumental status” as owing to its being one of the first manuals of its kind written in Dutch: see preface on pages v–viii in Gerard Arnold Nicolaas Allebé and G. A. Ootmar, De ontwikkeling van het kind naar lichaam en geest (Amsterdam, 1908); Knapper, Een kwart eeuw zuigelingenzorg in Nederland, 2. Knapper mentions that Cornelia de Lange celebrated the importance of the book in her inaugural lecture.
Gerard Arnold Nicolaas Allebé, De ontwikkeling van het kind naar ligchaam en geest (Amsterdam, 1845), v and 34.
Ibid., 2–3 and 285.
Von Ammon, De pligten der moeder, 44.
Bastiaan Schoolmann and Abraham Flipse, “‘De zoon, op wie zij trots was’. Voorgeschiedenis van de breuk tussen het Nederlandsch Tijdschrift voor Geneeskunde en de Nederlandsche Maatschappij tot Bevordering der Geneeskunst, 1856–1945,” Studium, 12 (2019): 91–109.
Samuel Senior Coronel, “Over het gewigt van jonggeborenen, in verband met de voeding en uitscheidingen,” ntg (1865), 602–603.
Idem, “Dood van jonggeborenen door uitputting en slechte voeding,” ntg (1866), 7–8.
J. Coert, “De gecondenseerde melk als kindervoedsel,” ntg (1883), 478–481.
L. de Jager, “Karnemelk als voedsel voor kinderen beneden het jaar,” ntg 31–ii (1895): 679–688; L. de Jager, “Karnemelk als voedsel voor kinderen beneden het jaar,” ntg 33–ii (1897): 606–610.
C. van Leersum, “Gaertner’sche Fettmilch,” ntg 31–i (1895): 401–404.
Simons, “Iets over de voeding van zuigelingen,” ntg (1887), 344.
“Berichten binnenland: Arnhem,” ntg 26–ii (1890): 456–459; “Berichten binnenland: Den Haag,” ntg 27–ii (1891): 655–657; W.C. Schimmel, “Politie-verordening betreffende het vervoer en den verkoop van melk te Berlijn,” ntg 35–i (1899): 527–531.
Van der Harst, “Karnemelk als kindervoedsel,” ntg 35–i (1899): 545–547; A. Mijnlieff, “Over voeding met en zelfbereiding van karnemelk,” ntg 35–i (1899): 633–635.
S.K. Hulshoff, “Over steriele melk en haar bereiding,” ntg 26–ii (1890): 213.
Nederlandsche Vereeniging voor kindergeneeskunde, Zij, Die Vooraan Gingen (Amsterdam, 1932).
A. Voûte and L. Scheltema, “Nederlandsche Vereeniging voor Paediatrie: bijdrage van Heijmans van den Bergh over ‘kindermelk’,” ntg 34–i (1898): 67–80; ten Siethoff, “Verslag Nederlandsche vereeniging voor paediatrie, 25 en 26 november 1898: over de voeding van het kind in het eerste levensjaar en in het bijzonde rover de voeding met de kindermelk,” ntg 35–i (1899): 235–249.
Eddy S. Houwaart, De Hygiënisten. Artsen, Staat & Volksgezondheid in Nederland, 1840–1890 (Groningen, 1991), 307.
Cf. J.M. Fuchs, “Sterftestatistiek,” ntg 1 (1857): 660–661; G. Scheltema and J. de Bruin, “Curiosa Uit de Sterfte-Statistiek,” ntg 29 (1885): 266.
Abraham Hartog Israëls, “De Sterfte Der Kinderen in de Drie Eersten Jaren Des Levens Te Amsterdam, in de Jaren 1850–1859,” ntg (1862), 289–302.
A.C. Cohen, “De Kindersterfte En Hare Betrekking Tot de Hoogte Des Bodems, Alsmede Tot de Vruchtbaarheid En de Bezigheden Der Bevolking,” ntg (1863), 535–537.
“Kindersterfte,” ntg 29–ii (1893): 426.
S.K.H., “Recensie: Kindervoeding, kinderverzorging en kindersterfte in het eerste levensjaar,” ntg 25–i (1889): 261–262.
“Kindersterfte,” ntg 40 (1896): 196–197. Italics added.
Geneeskundig Staatstoezicht, “Verslag aan de Koningin van de bevindingen en handelingen van het Geneeskundig Staatstoezicht in het jaar 1899” (The Hague–‘s-Gravenhage, 1899–1904, 1899), WorldCat.org.
K.H. Rombouts, Beschouwingen over het geboorte- en kindersterftecijfer van Nederland gedurende het tijdvak 1875–1899 (Harlingen, 1902), 3.
“Nederlandsche vereeniging voor paediatrie: discussie over kindersterfte,” ntg 38–ii (1902): 880.
David Armstrong, “The Invention of Infant Mortality,” Sociology of Health & Illness, 8 (1986): 214.
Stephan, “Het onvermogen tot zoogen,” ntg 44 (1900): 838.
J.M. Baart de la Faille and H. Treub, “Vijfde Vlaamsch natuur- en geneeskundig Congres. 4e afdeling, inwendige geneeskunde. Bijdrage van Miele van Gent, De verzorging van zuigelinge, voornamelijk in de werkende klasse,” ntg 32–ii (1901): 928–929.
This is a good example of where translations from English into Dutch involve a high degree of interpretation. What we have tried to do throughout the article is to translate Dutch notions into English words that represents best what we believe contemporary actor’s intended to say. In cases where our translations may be contested, we included the Dutch word in brackets.
E. J. Jonkers, Iets over kindervoeding en kindersterfte, meer speciaal in het 1e levensjaar (Groningen, 1902), 18.
Ibid., 18–23.
J. de Bruin and C. de Lange, De voeding van het kind in het eerste levensjaar, 3rd ed. (Amsterdam, 1904), 3.
Jonkers, Iets over kindervoeding en kindersterfte, meer speciaal in het 1e levensjaar, 30–31.
R. H. Saltet and G. Oosterbaan, “Handelingen der negen-en-vijftigste algemeene vergadering der Maatschappij. Sectie hygiëne,” ntg 52–ii (1908): 1168–1169.
Landelijk Onderwijs-Comité betreffende het voorbereidend onderwijs en de verzorging van zeer jonge kinderen in kinderbewaarplaatsen, De zorg der gemeenschap voor het zeer jonge kind ([The Hague], 1902).
Nationaal congres voor kinderbescherming, uitgaande van den Nationalen Vrouwenraad van Nederland (Amsterdam, 1908).
Christianne Smit, De Volksverheffers: Sociaal Hervormers in Nederland En de Wereld, 1870–1914 (Hilversum, 2015). A great example of this blurring of boundaries was the National Congress for Child Protection, organised by the Dutch Women’s Council in 1908, where attending feminists called for the organisation of maternity education to teach working-class mothers a “civil mentality of rest, right-mindedness, and regularity” (to render in English the alliteration in the Dutch original “rust, reinheid, en regelmaat”): Nationaal congres voor kinderbescherming, uitgaande van den Nationalen Vrouwenraad van Nederland (Amsterdam, 1908), 157.
G.J. Huet, “Prof. G. Scheltema I.M. 1864–1951,” ntg 92–i (1951): 334.
“Nederlandsche vereeniging voor paediatrie: Scheltema over kindersterfte vanuit sociaaleconomisch oogpunt,” ntg 40–ii (1904): 64.
B.P.B. Plantenga, “Verleden En Toekomst Der Zuigelingensterfte,” Tijdschrift Voor Sociale Geneeskunde 13–iii (1935): 51.
G. Scheltema, Kinderbescherming als eisch van zelfbescherming der maatschappij (Amsterdam, 1912), 28.
Ibid., 41.
A more detailed description of these early activities is provided elsewhere: see B.P.B. Plantenga, “Kindersterfte En Zuigelingenklinieken,” ntg 28–ii (1902): 922–928; E. Teixeira de Mattos, Over Bescherming en Verpleging van Jonggeborenen in Nederland ([Amsterdam], 1902); “Handelingen van de vijf-en-vijftigste Algemeene Vergadering te Breda,” ntg 40–ii (1904): 653–673; “Ingezonden Brieven: De Zuigelingenvoeding in de Armenpraxis,” ntg 40–ii (1904): 851–854.
For a more detailed history, see Nynke van den Boomen, “The Imperfections in Statistics: Interpretations of Causes of Infant Death in the Netherlands, 1875–1899,” Social History of Medicine, 35 (2022): 1064–1087.
Cf. Knapper, Een kwart eeuw zuigelingenzorg in Nederland, 4–8; Plantenga, “Verleden En Toekomst Der Zuigelingensterfte,” 48–49.
Cf. “Kindersterfte” (1893); “Kindersterfte” (1896); “Uitbesteding van zuigelingen,” ntg 31–i (1895): 990.
Alison Bashford, “Nation, Empire, Globe: The Spaces of Population Debate in the Interwar Years,” Comparative Studies in Society and History, 49 (2007): 170–201; Richard A. Soloway, Demography and Degeneration: Eugenics and the Declining Birthrate in Twentieth-Century Britain (Chapel Hill, NC, 1990).
R. H. Saltet and Gemeente Amsterdam, Bureau van Statistiek, Kindersterfte in Nederland (in de jaren 1881–1905) (Amsterdam, 1907), 3.
Herman Sterneberg, Zuigelingenvoeding en zuigelingensterfte te Nijmegen en de middelen ter verbetering (Amsterdam, 1907), 72.
Ibid., 60–72.
Ibid., 61, 72.
H.W. Methorst, “Geboorteachteruitgang en zuigelingenbescherming,” ntg 60–ii (1916): 1232.
H.W. Methorst, “Publikatie van H.W. Methorst over Geboorteachteruitgang En Zuigelingenbescherming” (1916), 1006–01: 25, Haags Gemeentearchief.
Methorst, “Geboorteachteruitgang en zuigelingenbescherming,” 1235.
Ibid., 1245–1246.
Ibid., 1259.
“Ned. bond tot bescherming van zuigelingen,” ntg 52–ii (1908): 1496.
Ibid., 1497. The Bond was chaired by obstetrician Hector Treub, an established public figure who used his authority to support charities aiming at improving the lives of young children and mothers. Nele Beyens, ‘Immer Bereid En Nooit Verlegen’. Hector Treub. Vrouwenarts in Een Mannenmaatschappij (Amsterdam, 2014), 241–242.
“Ned. bond tot bescherming van zuigelingen,” 1497.
P. Muntendam, “Bestrijding van de sterfte onder zuigelingen,” ntg 59–i (1915): 2052.
Nederlandsche Bond tot bescherming van zuigelingen, Statuten van den Nederlandschen Bond tot Bescherming van Zuigelingen (Amsterdam, 1914).
This was never part of the propaganda of the League. However, the annual reports written by Carstens reveal a nationalist tendency explicitly referring to the First World War. The annual report of 1916 contains a good example: Nederlandse Bond voor Moederschapszorg en Kinderhygiëne, “Jaarverslagen, Opgemaakt Door de Secretaris En Later Door de Directeur. 1915–1966” (1915), 6.
Nederlandsche Bond tot bescherming van zuigelingen, Beschamende zuigelingensterfte (Amsterdam, 1915), 15.
Op. cit.
B. J. Kouwer, Nog altijd: beschamende zuigelingen-sterfte (Amsterdam, 1920), 7.
“Nog altijd: beschamende zuigelingen-sterfte,” ntg 64–i (1920): 834–835.
In 1899, approximately 35 per cent of the Dutch population was Catholic and 48 per cent Protestant (Nederlands Hervormd) while in 1930, both religious communities counted 35 per cent of the Dutch population among its members: see Engelen, “Van 2 Naar 16 Miljoen Mensen,” 26.
This conclusion has been validated using the standards of modern demographic analysis by Evelien Walhout. Her thesis offers more detailed analyses of why infant death was more prevalent among Catholic families: see Walhout, “An Infants’ Graveyard?”
Notulen der najaarszitting van 1915, blz. 66, as quoted in Jan Truyen, De kindersterfte in Limburg (Leiden, 1918), 3.
Truyen, De kindersterfte in Limburg, 40.
P. E. G. van der Heijden, De zorg voor moeder en kind in Noord-Brabant (Amsterdam, 1934), 116; Walhout, “An Infants’ Graveyard?” 107; Cornelis Meuleman, Het levensrecht van de geboren vrucht (Bussum, 1916), 23–24.
Jehan Kuypers, Uit de geschiedenis van de R.K. Vereeniging ‘Moederschapszorg’ te Heerlen (Roermond, 1937).
Meuleman, Het levensrecht van de geboren vrucht, 23.
Ibid., 19.
Ibid., 21.
Ibid., 31.
Ibid., 48.
M. van der Kolk-Kousemaker, “Het beleid van Het Witte Kruis, Het Groene Kruis en Het Wit-Gele Kruis over de periode 1875–1945” (Netherlands, 2005), 56–61.
Ibid., 86–136; Kuypers, Uit de geschiedenis van de R.K. Vereeniging ‘Moederschapszorg’ te Heerlen, 7; Kolk-Kousemaker, “Het beleid van Het Witte Kruis,” 78.
Ibid., 78–79.
Wit-Gele Kruis, “Circulaire ‘de Opzet van Het Wit-Gele Kruis’,” Katholiek Documentatiecentrum (1925), 2925; Kolk-Kousemaker, “Het beleid van Het Witte Kruis,” 154–159. Italics added.
Kolk-Kousemaker, “Het beleid van Het Witte Kruis,” 165.
Nederlandsche Bond tot bescherming van zuigelingen, Beschamende zuigelingensterfte.
Eerste Kamer der Staten General, “Handelingen Eerste Kamer 1920–1921 04 Maart 1921,” Pub. L. No. 239, 298, 307, 337, 340, 1920–1921 (1921), 496.
Tweede Kamer der Staten Generaal (hereafter: tksg), “Aanvulling En Verhooging van Hoofdstuk X A Der Staatsbegrooting Voor 1920; VOORLOOPIG VERSLAG,” Pub. L. No. 462.3, 1919–1920 (1920), 462.
tksg, “Handelingen Tweede Kamer 1923–1924 10 April 1924,” Pub. L. No. 2, 1923–1923 (1924), 1871.
tksg, “Handelingen Tweede Kamer 1924–1925 25 November 1924,” Pub. L. No. 2, 1924–1925 (1924), 668.
tksg, “Staatsbegrooting Voor Het Dienstjaar 1925 (Departement van Arbeid, Handel En Nijverheid); VOORLOOPIG VERSLAG,” Pub. L. No. 2X5 (1924), 5.
tksg, “Staatsbegrooting Voor Het Dienstjaar 1921 (Departement van Arbeid): Memorie van Toelichting,” Pub. L. No. 2 X A, 1920–1921 (1921), 11.
tksg, “Handelingen Tweede Kamer 1921–1922 02 Februari 1922,” Pub. L. No. 2, 1921–1922 (1922), 1387.
Ibid., 1388; tksg, “Handelingen Tweede Kamer 1921–1922 07 Februari 1922,” Pub. L. No. 2, 1921–1922 (1922), 947.
tksg, “Handelingen Tweede Kamer 1925–1926 24 Maart 1926,” Pub. L. No. 198, 2, 72, 1925–1926 (1926), 482; tksg, “Handelingen Tweede Kamer 1926–1927 07 December 1926,” Pub. L. No. 2, 1926–1927 (1926), 965; tksg, “Handelingen Tweede Kamer 1926–1927 01 December 1926,” Pub. L. No. 2, 1926–1927 (1926), 862.
tksg, “Handelingen Tweede Kamer 1926–1927 07 December 1926,” 966. Italics added.
R. N. M. Eijkel and Nationale Raad voor Maatschappelijk Welzijn (Netherlands), Overzicht over het sociaal hygienisch werk in Nederland op het gebied van den dienst der volksgezondheid: hygiene van het kind, bestrijding der tuberculose, bestrijding van de geslachtsziekten: (aangeboden aan zijne excellentie den minister van arbeid, handel en nijverheid door de hoofdinspecteur van de volksgezondheid Eykel), 2e herziene dr. (‘s-Gravenhage, 1932), 28.
Ibid., 46–51.
Ibid., 29–30.
Dewey, Public and Its Problems, 93.
Ibid., 87.
Cf. I. Hacking, “Kinds of People: Moving Targets,” Proceedings of the British Academy, 151 (2007), 285–318.
Dewey, Public and Its Problems, 69.
Van der Meer, Van der Zee and Jacobs, “A Good Mother Enters the Clinic”.
Dewey, Public and Its Problems, 83.
