In the nineteenth century, the continuous discharge of sewage from millions of Londoners into the River Thames caused a notorious, unbearable stench during the summer, which reached a climax in 1858 and became known as The Great Stink. In this article it is argued that such a ‘Great Stink’ also occurred in the booming and heavily populated pre-industrial town of Leiden, because cesspits were being replaced by sewers draining directly into canals. Flawed as cesspits may have been, the new, hygienic sewer infrastructure meant the advent of unsanitary conditions normally only associated with the era of the Industrial Revolution. How and why the cesspit was killed off is explained by comparing Leiden with the seventeenth-century boom town of Haarlem, where cesspits remarkably survived the ‘Golden Age’ of the seventeenth century. Using the stakeholder model it becomes clear that the shift in hygienic infrastructure was not the outcome of a single stakeholder calling the shots but was the result of interactions between tenants, housing developers, local government, and textile entrepreneurs (in the case of Leiden), or brewers (in Haarlem).