As elsewhere in Europe in the middle of the nineteenth century, general dissatisfaction among Dutch doctors with their position in society and with overall levels of public health led to an active endeavour to raise their own status and to improve the level of public hygiene. For the most part these sanitary reformers or hygienists were inspired by the ‘Bodentheorie’ (literally ‘soil theory’) of the Munich hygienist Max von Pettenkofer, which postulated a specific relationship between chemical and biological processes in soil and air and in the human body, and by the Belgian statistician Adolphe Quetelet, according to whom statistics were an important means to social progress. The hygienists stressed the need for objective measures of health, including empirical research, standardization of data collection, and increased dissemination of data.

Although a national system of death registration had been functioning in the Netherlands for more than thirty years, there was no national registration of causes of death. Only local registration of causes existed and these were considered insufficient and inaccurate.