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ABSTRACT
This article examines the locus of care of the elderly in the cities of Antwerp, Brussels and Ghent at the end of the eighteenth century by investigating the circumstances of their decease. The article uses a cross-sectional analysis of the municipal death registers of 1797 to shed light on the informal networks and formal provisions that surrounded the urban elderly (aged 60 years and older) during their last days and shortly after their death. By evaluating the roles of hospitals and private houses as places of death and the presence of family and neighbours as witnesses, the article assesses both formal and informal channels of support. In addition, the article examines how the locus of care correlated with marital status, socio-economic position and migration background.
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Notes
1. Some of the key works on the social history of old age consequently focus on the role played by exactly such institutions in providing assistance to the elderly (Botelho, 2004; Botelho et al, 2002; Ottaway, 2004).
2. Municipal Archives of Antwerp (MAA), 143#202 and 143#203: Registers met de overlijdensakten, 1795–1797 and 1797–1799; Municipal Archives of Brussels (MAB), Registres des décès, 22/09/1796-31/12/1940, 1797; Archives of the Civil Administration of the City of Ghent (ACACG), Overlijdensregisters, 1797.
3. The average time lag between the date of death and the registration date in Antwerp, Brussels and Ghent was 1,5 days.
4. Own calculations based on Municipal Archives of Antwerp, 143#202 and 143#203: Registers met de overlijdensakten, 1795–1797 and 1797–1799; Municipal Archives of Brussels, Registres des décès, 22/09/1796-31/12/1940, 1797; Archives of the Civil Administration of the City of Ghent, Overlijdensregisters, 1797 and ‘WerkdocumentenVT IV’.
5. Because deaths in Brussels and Ghent institutions were reported by the same few staff members and directors, the total number number of witnesses is not twice the number of deaths, but is somewhat lower. In Ghent, for instance, Simon Jean De Noter, director of the Bijloke hospital, reported all the deaths that occurred within his institution with the municipal administration. As a consequence, all deaths within this institution were reported by the same witness.
6. At the end of the eighteenth century, the Saint-Elisabeth hospital had 106 beds, which offered a total of two hundred places (Verhelst, Citation1993, p. 36.) According to a 1781 report, the Saint-Jean hospital in Brussels was capable of lodging 120 sick. However, its real capacity possibly amounted to even more, as its 77 beds could (and often did) lay two to three sick (Guilardian, Citation2011, p. 369; Dickstein-Bernard, Citation1977, pp. 55–82). With 78 beds in 1781, the Saint-Pierre hospital had an overall capacity that was similar to that of the Saint-Jean hospital. During the same period, the Bijloke hospital had a capacity of 69 beds, which could offer place to in between 140 and 210 patients. (Guilardian, Citation2011, p. 369; Dickstein-Bernard, Citation1977, p. 60; Verhelst, Citation1993, p. 36.)
7. Hospitals generally refused to accept infants and children. For this reason, it is better to compare the proportion of elderly among the adult populations, those aged 20 years and older, of the city and hospital. At the end of the eighteenth century in Ghent, elderly made up a proportion of 26% of all adult hospital patients. (L. Maris, Citation1990, pp. 45–48). This was ten percent more than the proportion they made up in the general adult urban population, which was 17%. Moreover, the evidence for Ghent also suggests that the hospital, proportion-wise, was equally important for male and female elderly. The elderly male and female proportions among the Bijloke patients, respectively 12 and 14%, (L. Maris, Citation1990, pp. 45–48) were comparable to their proportion in the general urban adult population, 7 and 10% (source: ‘WerkdocumentenVT IV’).
8. In general, mortality in the late-eighteenth-century urban hospitals was very high. Between one in ten and one in five patients in Saint Pierre (12%), Saint Elizabeth (19%) and Bijloke (15%) hospital died in the institution. (see Appendix 2) This was three to five times the general urban mortality rate at that time, which was 4% in Brussels and Antwerp and 3,4% in Ghent. (Source: own calculations based on MAA, 143#202 and 143#203: Registers met de overlijdensakten, 1795–1797 and 1797–1799; MAB, Registres des décès, 22/09/1796-31/12/1940, 1797; ACACG, Overlijdensregisters, 1797 and ‘WerkdocumentenVT IV’). The mortality rates experienced by elderly patients were even higher, as is suggested by the Ghent data. While during the year VI, in total 229 elderly patients were admitted to the Bijloke, 68 elderly died in that institution during the year 1797, an elderly mortality rate of 30%. This was twice the general hospital mortality rate and almost four times the urban elderly mortality rate of 8%.
9. While elderly deaths made up 31, 21 and 25% of the total number of death in Antwerp, Brussels and Ghent, they made up an even larger part of the hospital deaths, 47% in Ghent and 41% in Antwerp as well as in the Saint-Pierre hospital in Brussels. In the Saint-Jean hospital, at that moment Brussels largest hospital, their proportion was somewhat lower, 35% (see Appendix 2).
10. Only in 1808, elderly men were transferred to the general almshouse and elderly women followed even later, in 1811 (Vander Rest, Citation1860, pp. 53–54).
11. In Ghent, during the second half of the eighteenth century, these paying patients made up 5% of the total number of patients. (De Commer, Citation1988, p. 133). In Antwerp, the Saint Elizabeth hospital made available 21 beds to such boarders. If we assume that the 81 beds reserved for regular patients laid 162 patients, the 21 paying customers would make up 11% of the Saint Elisabeth’s total capacity of 183 patients. Depending on the prosperity of the patient, a price was agreed upon, which could consequently vary considerably, from four to ten stivers per day in Antwerp to up to one guilder per day in Brussels.
12. Researchers should be mindful however of the different trajectories of many of these institutions, even within the Low Countries. While, some hospitals or monasteries offering corrodies did indeed develop into full-fledged old age institutions (Zuijderduijn, Citation2015, Citation2016), this was not the case for the urban hospitals at study here. Vermeiren and Hansen (Citation1998, pp. 182–183) for instance, nuance the overall impact of commercial provisions for elderly on the general patient profile of the Antwerp Saint-Elisabeth hospital, which primarily continued to consist of young poor labourers. However, the presence of paying elderly patients does impact the perception of poor hospitals as places for the elderly. De Commer (Citation1988, pp. 133–134) for instance, finds that the patients of the Saint-Elisabeth hospital were mainly elderly and/or gravely ill. In a similar way, contemporaries often complained that the overcrowding of the urban hospitals was among others caused by too large numbers of elderly patients who should instead be cared for in separate old-age institutions (Dickstein-Bernard, Citation1977, p. 65). The figures presented in this article nevertheless indicate that, while the elderly were indeed a significant group within the hospital, they still only made up a minority of one in four of the total patient population.
13. Although occupational information is not provided consistently in the death records, a modest analysis is possible. shows the proportion of elderly deceased per place of death by socio-economic group. These groups have been created using the categories from the HISCLASS scheme (Van Leeuwen & Maas, Citation2011), where the elite group combines all elderly with an occupation from HISCLASS groups 1 up to and including 4, the middle-class group consists of HISCLASS groups 5 up to and including 8, the group of lower-skilled workers corresponds to HISCLASS group 9, and finally, the group of unskilled workers corresponds to the HISCLASS group 11. These groups provide an indicative sample that illustrates the impact of social class on the locus of care in terms of place of death.
14. We should, however, nuance the information we have for single men, because the empirical basis for this analysis is extremely small: only 5 single men were explicitly recorded as such in Brussels and 6 in Ghent.
15. It is possible that the Antwerp municipal administration stipulated that the registration process of deaths had to be carried out by family witnesses. Such a prerequisite would, if enforced, explain the observed large numbers of family relations as witnesses. Such a prerequisite would, if enforced, explain the observed large numbers of family relations as witnesses. Even if such a preference was exercised, however, this does not undermine our findings. The witness information is in this regard less likely to reveal the ready available networks that immediately surrounded the elderly, nor the relations that were quickly called upon to report the death with the administration in order to relieve the more intimately related bereaved, but provides perhaps the most realistic and complete image of the presence of family relations within the city.
16. Informal networks are the inter-personal relations that existed between households and individuals outside of institutions. Typical examples are the relations between family members, friends and neighbours. Formal relations are the ones which stem from institutions. Some formal witnesses were, for instance, police officers, poor relief officials or poor doctors. Some relations are more ambiguous: they can be considered informal, although they were formed against the backdrop of a formal arrangement. Examples are the relation between employer and employee or servant and master. The witness relationships that surrounded deaths in private houses can be considered largely informal. Less than one per cent of witnesses relations were unambiguously formal in nature, mostly private nurses and poor doctors, and some relations, such as those between lodgers and those who sublet their room, existed in-between. However, we focus on the two most important categories, those of family on the one hand and neighbours and friends on the other, which can be considered classic examples of informal networks.
17. This estimate is the result of a simple calculation based on present-day maps provided by Google Maps, identifying the maximum distances as the largest cross-section of the historical inner-city areas, which confines to the areas between the cities’ former city walls, namely the Antwerp area between the ‘Leien’, the Brussels ‘Vijfhoek’, and the area between Ghent’s ring road.
18. Here I only consider the witnesses of those deceased who died in a residence that was not recorded as belonging to someone else. I assume that these elderly died in their own residence, however, it is possible that the administrators did not consistently register whether an individual died at home or in someone else’s dwelling. Unfortunately, we do not have insight into the households of the elderly. We cannot differentiate between street address and household. As a consequence, we cannot exclude that witnesses who had the same street address did not live in the same household as the deceased. Likewise, we cannot ascertain whether so-called friends or neighbours were no t, in fact, co-residents or lodgers.
19. Blondé and Verhoeven have shown how time awareness in eighteenth-century Antwerp was already clear-cut and precise along all genders, ages and socio-economic groups. Bruno Blondé and Gerrit Verhoeven, ‘Against the Clock: Time Awareness in Early Modern Antwerp, 1585–1789ʹ, Continuity and Change, 28.2 (Blondé & Verhoeven, Citation2013), 213–44 (pp. 222, 234)
20. Source: own calculations based on MAA, 143#202 and 143#203: Registers met de overlijdensakten, 1795–1797 and 1797–1799; MAB, Registres des décès, 22/09/1796-31/12/1940, 1797; ACACG, Overlijdensregisters, 1797 and ‘WerkdocumentenVT IV’.
21. Note: these figures only concern the 23 witnesses of those elderly who died in private houses and for whom address information on both the witness and the deceased was available. 12 of them lived in the same street, 7 lived within five minutes, 1 between five and fifteen minutes and 3 lived more than fifteen minutes away from the deceased. For 17 other friend witnesses, address information on the deceased was missing.
22. Note: these figures only concern the witnesses of those elderly who died in private houses, not those who died in institutions, the beguinage or a religious congregation. In Ghent, 113 neighbour witnesses lived in the same street as the deceased, 6 lived in a different street and for the other 33 witnesses address information on either the deceased or witness was missing. In Brussels, 12 neighbour witnesses did not live in the same street, while address information on witness or deceased lacked for another 22 neighbours.
23. MAB, Archives historiques, Registres paroissiaux, Bruxelles, Hôpital Saint-Jean, Registre de décès: manuscrit, 1695–1796; MAB, Archives historiques, Registres paroissiaux, Bruxelles, Hôpital Saint-Pierre, Registre de décès: manuscrit, 1794–1796.
24. ACACG, Overlijdensregisters, 1797.
25. MAA, 143#202 and 143#203: Registers met de overlijdensakten, 1795–1797 and 1797–1799.
26. MAB, Archives historiques, Registres paroissiaux, Bruxelles, Hôpital Saint-Jean, Registre de décès: manuscrit, 1695–1796; MAB, Archives historiques, Registres paroissiaux, Bruxelles, Hôpital Saint-Pierre, Registre de décès: manuscrit, 1794–1796.