Museumbulletin 2011 - nr 3 - English version

mUsEUm Quarterly magazine - Volume 31, July-Sept 2011

BUllETIN

from surgeons to plague saints

illness in bruges in the sixteenth and seventeeth centuries

EXHIBITION 29 sEpTEmBEr 2011 - 26 FEBrUArY 2012 BrUGEs, mEmlING IN sINT-JAN - HOspITAAlmUsEUm

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Foreword 3 Introduction 4 Two centuries of innovative ideas and barely changing medical practice

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Public safety, hygiene and disease prevention

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Care of citizens in sixteenth and seventeenth-century Bruges

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Care providers in the sixteenth–seventeenth century

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Medical books published in Bruges

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The emergence and disappearance of infectious diseases in Bruges in the sixteenth and seventeenth centuries

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The plague in Bruges

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Cutting for the stone in seventeenth-century Bruges

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The Medionaet: a less familiar surgeon’s duty during corporal punishment in Bruges

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Pharmacists in Bruges in the sixteenth and seventeenth centuries

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A passport to heaven. Veneration of saints in the sixteenth and seventeenth centuries

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A look at death in sixteenth- and seventeenth-century Bruges culture

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museumbulletin > directie

dear museum friend, dear reader, The building, the history and the collections of Sint-Janshospitaal illustrate a unique and extraordinary story – one stretching back for centuries – of care for the body and the soul. All too often, the public focuses exclusively on the marvellous group of works here by Hans Memling. Yet there is much more to Sint-Janshospitaal than those paintings, even though they are among the city’s crowning artistic glories. The complex of which it forms part is testimony to an eventful history of more than eight centuries of health care.

While we should not underestimate its importance to the treatment of bodily ailments in the late Middle Ages, the hospital’s predominant concern for many years was caring for the soul, comforting the dying and preparing them for the afterlife. As you will see in this special issue of the Museum Bulletin, all that began to change rapidly in the sixteenth century. Although spiritual care remained very much to the fore until the end of the eighteenth century, fundamental changes occurred in sixteenth- and seventeenth-century Europe in medicine and health care: developments that laid the foundations for the medical treatment we know today.

It is an intriguing thought that this remarkable blend of continuity and innovation in medical knowledge and practice was concentrated at a single location in Bruges for over eight centuries. The hospital did not leave the site until 1976, when it relocated to the edge of the city, physically separating the historical collections from contemporary health care. The intrinsic

link between the ‘old’ and the ‘new’ Sint-Janshospitaal has nevertheless remained, not least because OCMW Brugge – the municipal social services organization and heir to the former hospital trustees – continues to administer the modern institution and still owns the celebrated collections at the old Sint-Janshospitaal. The management, conservation and museum presentation of those collections were, however, entrusted over twenty years ago to the Bruges municipal authority and to Musea Brugge.

It was the firm wish of both Musea Brugge’s administrators and the staff of the Hospitaalmuseum to organize a temporary exhibition to fill the many gaps in the permanent collection that have prevented the full story from being told of health care prior to 1800. The recent, authoritative publication by Dr Pannier – full of fresh insights – on the history of medical care in Bruges in the sixteenth and seventeenth centuries offered an ideal opportunity to realize that dream. I am exceptionally grateful to Dr Pannier and to Montanus vzw – a group of enthusiastic Bruges medical specialists committed to the study and presentation of the history of medicine in the city – for offering their expertise and helping develop the substantive concept of the exhibition. Without their passion, unselfish effort and specialist knowledge, neither the exhibition nor this publication would have been possible.

Our sincere gratitude is also due to the municipal authorities, the working group, the exhibition partners (Stedelijke Openbare Bibliotheek Brugge, Stads- en Rijksarchief Brugge), the technical

workshop and all the authors. We are equally grateful to the OCMW Brugge, and especially to curator and archivist Hilde De Bruyne, who has actively supported the project from the outset. It goes without saying too that this venture would not have been possible without the contribution of many people at Musea Brugge. I would also like to thank our colleagues at the Hospitaalmuseum, particularly the project coordinator, Sibylla Goegebuer. PK Projects – an established partner of Musea Brugge – is responsible for the attractive design of the exhibition. And a special word of thanks, of course, must go to all the lenders, who were willing to entrust their precious items to the exhibition.

I very much hope that we succeed in conveying our fascination for this subject to the people who visit the exhibition and who read this Bulletin. The occasion also provides the perfect opportunity for visitors to renew their acquaintance with Sint-Janshospitaal and the magnificent collections it contains.

Manfred Sellink

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introduction This exhibition focuses attention on a crucial page in the history of medicine and health care in the sixteenth and seventeenth centuries. The innovation that occurred in that period did not result from a gradual, rational evolution but formed a clean break with the past. Renewed contact with classical literature prompted a return to the source, tipping medical thinking away from philosophy and toward science, from guesswork to empirical knowledge. Reason won out over speculation. This sudden turnaround in the approach to medicine did not, however, translate immediately into medical practice: it would take three centuries to bear full fruit.

The improved understanding of the structure and function of the human body achieved by a number of brilliant innovators in the sixteenth and seventeenth centuries prepared the ground for modern medicine. Medical practice ceased to be based on the teachings of Hippocrates, Galen and Avicenna, which had been its underpinning for centuries. The supposed influence of the stars and other heavenly bodies on diagnosis, prognosis and therapy also ceased to hold

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true, and the beneficial effects of the bleeding, laxatives and sweat cures that had long formed the basis of treatment were likewise called into question. Belief faded too in the diagnostic and healing powers of precious stones.

It was also in the seventeenth century that forensic medicine emerged within medical practice. The distinction was maintained at social level between physicians – the supposed intellectuals – and surgeons – the ‘manual workers’ who carried out the practical work. Physicians and surgeons were organized into separate confraternities and guilds, each with their own seal and by-laws. A decree of Emperor Charles v in 1540 required every physician to complete a university education before being permitted to practise his profession. A similar requirement was not introduced for surgeons until the second half of the nineteenth century. Pharmacy had been an autonomous branch of medicine since 1231, again with its own seal and rules, despite which the relationship between physicians and pharmacists was often a fraught one in the seventeenth century.

The role played by Bruges in the transformation of medicine in the sixteenth and seventeenth centuries ought not to be underestimated. The city’s humanist take on charity sparked new thinking within the conception of health care.

All these aspects of the history of medicine are explored in detail in the exhibition.

It is our pleasure, therefore to congratulate the three different partners – Musea Brugge, Montanus vzw and the OCMW-Brugge – whose intensive collaboration has culminated in a coherent and fascinating exhibition.

R.A.C. Pannier

Honorary Chairman Montanus vzw

two centuries of innovative ideas and barely changing medical practice Ludo Vandamme and Johan R. Boelaert

The ‘new’ world of the sixteenth century spanned the globe for the first time. World trade shifted with it from the Mediterranean to the Atlantic space, while large, centrally governed global empires became laboratories of modern state thinking. The most powerful of these was the Spanish Habsburg empire on which ‘the sun never set’ and to which the Low Countries also belonged.

Not only had the world changed, above all people viewed it differently: it became a world of and for the people. This immense interest in human beings and in humanity found its purest expression in humanism – a broad intellectual movement that spread from Italy throughout Europe, achieving a widespread social and religious impact. Critical thought now began to reject slavish adherence to established commentaries on the supposed sources of knowledge, the auc-

toritates. Humanists wanted to examine these authorities at first hand. They feverishly sought out authentic sources from antiquity and early Christianity ad fontes: the Bible, of course, but also Justinian, Galen, Plato and Aristotle, among many others. Language and art were also tested against the idealized image of antiquity. Some wanted to go even further, to build a new, ideal society, although they did not get much further at this point than the blueprint Thomas More set out in his Utopia. Humanism owed much of its dynamism to the art of printing, which for the first time allowed texts to be produced and distributed quickly and affordably, enabling new ideas, insights and convictions to be picked up immediately among scholars or shared by large swathes of the population. Without the book printers, Protestantism would never have developed into a mass movement that brought about a permanent schism in the Western Church.

Bruges, with its 30–40,000 inhabitants, was the metropolis of the ‘old world’, no longer a hub of the new, global economy. That role passed to Antwerp, whose population grew rapidly in the sixteenth century to around 100,000. Nevertheless, Bruges remained a compelling, international city, with lively trade, diverse and high-quality manufacturing, and a sophisticated intellectual life. Erasmus of Rotterdam (1466?–1536) described Bruges as the ‘Athens of the North’, and while the celebrated Dutch humanist could always be relied on for a bold statement, there was something in his claim. Erasmus had many friends and kindred spirits in Bruges, and even considered setting permanently in the city.

Bruges’s fine manners, sociability and concern about the urban community made life there very pleasant: there was more to humanism, after all, than just the exploration of ancient wisdom in

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scholars’ studies and libraries. Education and upbringing were, moreover, the key to preparing young people for this new world – a responsibility of which the Bruges-based Spanish humanist Juan Luis Vives (1493–1540) indefatigably reminded the civic authorities and parents. The driving force behind humanist intellectual life remained, however, the pensionaries and administrative circles centred on Bruges’s town hall and the canons and other clerics in the chapters: that of Sint-Donaas chief among them. Within these circles, the latest books passed readily from hand to hand. The city’s commercial star had waned too much for it to develop a vigorous book trade. Likewise, attempts to add an academic superstructure to the network of Latin schools got little further than the foundation of a ‘Collegium Bilingue’ (1540) for the study of Latin, Greek and theology. From the second half of the sixteenth century, moreover, humanist intellectual life was increasingly harnessed as an instrument for monitoring religious orthodoxy. This trend continued in the seventeenth century, when the triumphalist Catholic Counter-Reformation came to dominate artistic and intellectual life in the cities.

A ‘new’ world had opened up in the sixteenth century, in which human beings seemed capable of achieving anything. This optimism soon found itself constrained, however, by physical and intellectual restraints. Marguerite Yourcenar powerfully captured this struggle against the prevailing restrictions in the person of Zeno, the main character of her novel The Abyss. Is it a coincidence that Zeno the physician transports us back into the medical world of sixteenthcentury Bruges?

What drove medical thinking before it took a new turn under humanism? Medieval ideas about health and illness rested on three pillars: Hippocratic Galenism from antiquity, astrology and Christian scripture. Hippocrates, medicine’s founding father in the fifth century bce, and his successor, Galen, in the second century ce, established a doctrine based on harmonious relationships within the universe, and especially

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between man and the four primary elements of the universe: earth, water, air and fire. The human body was composed of four corresponding principles: the four bodily fluids or ‘humours’: black bile, phlegm, blood and yellow bile. Health was defined in terms of a harmonious balance between these four humours, while illness was attributed to the disruption of the same balance, which treatment therefore sought to restore.

The second pillar consisted of astrology, which had its roots in the same ancient philosophy of harmony between man and the universe – the macrocosm and the microcosm. This theory highlighted the favourable or unfavourable influence of heavenly bodies on the human body.

Treatments such as bleeding therefore had to take account of the position of those heavenly bodies, particularly the planets and the constellations of the zodiac. The third pillar was Christi-

an doctrine, which interpreted disease as God’s scourge to punish humanity or individuals for their wickedness. This was counter-balanced by Christ’s healing of the sick, and the care shown towards invalids by numerous saints and their miraculous cures.

The fresh wind of humanism began to shake the dogmas of Hippocratic Galenism, revealing certain gaps and errors and, as the early modern period dawned in the sixteenth century, causing the first cracks to appear in the two-millenniaold system. Few went as far as the German scientist Paracelsus, however, who publicly burned the writings of Galen as a token of his contempt for the established scholarly tomes. Such iconoclastic behaviour was the expression of a quest for a new vision toward medicine. While Paracelsus himself was unable to achieve that visi-

1 Andreas Vesalius, Compendiosa totius Anatomie delineatio, ….

1545. Bibliothecae Dunensis 1758 Stedelijke Openbare Bibliotheek Brugge ‘De Biekorf’, inv. 2322 Pagina met ‘quarta musculorum tabula’ 2 Aurelius Cornelius Celsus, De Arte Medica libri octo, multis in locis iam emendationes longè, quam unquam antea, editi, 1552.

Bibliothecae Dunensis 1629 Latin translation of Celsus’s book, done from the Greek

by Willem Pantin of Tielt, who practised medicine in Bruges.

Stedelijke Openbare Bibliotheek Brugge ‘De Biekorf’, inv. 2299 Titelpagina 1

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on, he nonetheless introduced chemicals, including minerals, into therapy. Johan Baptist van Helmont, who came from the Duchy of Brabant, emphasized the importance of chemical processes in the body. Andreas Vesalius, also from Brabant, was a pioneer in the field of structural anatomy, publishing his findings in an excellent work entitled De humani corporis fabrica (‘On the fabric of the human body’, 1543) (Fig. 1).

An abridged version was published in Bruges with the name Dat epitome (1569). Vesalius had been able to perform accurate dissections of corpses, primarily in Padua, which enabled him to discover errors in Galen’s system, the anatomical knowledge of which derived from animal dissections. Anatomical research continued to develop in the seventeenth century, not only in terms of structure but above all in pursuit of functional relationships. Anatomical and especially physiological knowledge of the circula-

tory system was established in England by William Harvey (1628), refuting once and for all Galen’s assertion that the veins contained blood but that air flowed through the arteries. Humanism also brought new knowledge of infectious diseases. In 1546, the Italian Girolamo Fracastoro made a tentative yet visionary step toward the notion that ‘germs’ are the cause of infectious diseases rather than a disruption in the balance of the humours. The time was not yet ripe for this idea, however, and it would not be until the second half of the nineteenth century that this ‘germ theory’ was proved correct. Anthonie van Leeuwenhoek, using a selfmade microscope, nevertheless managed to observe ‘animalcules’ corresponding with what we now refer to as ‘bacteria’ in 1676. Did the humanist movement achieve any medical advances in Bruges too?

innovation The answer is that it did indeed. The innovation in question included the much-needed critique of the abuse of certain medical practices, broadening the study of nature, a more organized approach to infectious diseases and improved training and structuring of the medical professions. Several Bruges-based thinkers in the sixteenth century recognized the malpractices arising from the old belief in astrology’s role in health and disease. The aforementioned Juan Luis Vives challenged astrology’s status as a science, while various doctors, including Cornelius Duplicius Scepperus and above all François Rapaert, vigorously resisted the application of astrology for medical ends and the astrological predictions published in almanacs:

‘that one ought not to follow planets alone when curing diseases’ (1551). The number of health forecasts proclaimed by the almanacs gradually declined in response. In a similar display of rationalism, both Vives and Rapaert mounted equally firm resistance against the ubiquitous malpractices of the traditional healers, ‘the tyrannical murderousness of the charlatans’.

Unsurprisingly, Rapaert also railed against the practice of uroscopy – the visual examination of a patient’s urine, which doctors applied for diagnostic purposes and which was frequently misused by quacks.

Innovation was not limited to the critique of abuses: in the mid-sixteenth century, several Bruges physicians published translations of works by the Romans Galen (1538) and Celsus (1552) and the Byzantine Actuarius (1554), facilitating a more thorough study of these ancient texts (Fig. 2). Another Bruges man, Anselmus Boëtius de Boodt is still celebrated for his thorough and wide-ranging study of nature.

He spent time at the imperial court in Prague, where he focused on the study of rocks and precious stones. As a physician, he also described the medical uses of these stones (1604).

He was not only interested in the world of minerals but also that of plants, publishing a herbal (Fig. 3) and producing excellent hand-coloured drawings of plants. Karel van Sint-Omaars, who commissioned artful, coloured drawings of the plants in the garden of his chateau in Moerkerke, is also worth mentioning in this regard. Less innovative but still worth noting is the 1697 Bruges pharmacopoeia by Johannes Vanden Zande, which followed the examples published by cities like Brussels, Antwerp and Ghent.

The quality of medical training in Bruges made substantial advances in the sixteenth and seventeenth centuries (see also M. Deruyttere’s article in this publication). In his 1531 book on the subject, Vives advised would-be physicians to study not only the ancient writers, but also botany and anatomy, the latter by attending dissections of the human body. This theoretical knowledge was to be supplemented by an

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Greater cohesion was sought in the seventeenth century between the different groups of health workers: between individual physicians; between physicians and other health professionals; and between the medical profession in general and the authorities. Just as the surgeons had united in the Middle Ages in the guild of Saints Cosmas and Damian, the physicians – under the impulse of Thomas Montanus – now came together to form a disciplined group in the shape of a Confraternity of St Luke (1665). The foundation (1603) of the Camer vande gesondheyt (‘Health Chamber’), comprising the burgomaster and alderman, together with two physicians and a surgeon (1625), extended the scope of the functions hitherto performed by the municipal physician. Montanus attempted to group all of Bruges’s medical professions but without success: it was not until the mid-eighteenth century

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apprenticeship with an experienced physician.

Vives also stressed the good conduct and ethics required of the physician. In 1540, Emperor Charles issued an edict imposing a legal requirement on physicians to undergo training at an accredited university. The training of surgeons was also evolving. During the same period, the Bruges surgeon Jan Pelsers compiled a textbook to prepare candidates for the surgeon’s and barber’s examination (1565). At the request of the Bruges civic authorities, he and the physician François Rapaert instituted anatomy lessons in the local prison, where the instructors were allowed to use the corpses of executed or otherwise deceased prisoners, ‘provided they do so discreetly’ (1561). Similar but less furtive dissections were held a century later in the caemer der chirurgie – an anatomical theatre, the instructors at which included the surgeon Cornelis Kelderman (1675). The 1517 charter of the barbers’ guild specified in great detail the rights and duties of its members. The midwives too were required to pass an exam (1551), reflecting the onerous responsibility associated with the task performed by these wise women, as physicians and even surgeons were rarely if ever called on to intervene in deliveries

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and their possible complications. The surgeon Cornelis Kelderman later published a little book with practical guidelines for midwifery (1697).

It goes without saying that the pharmacists too were unable to escape the regulation of the medical professions. Having clearly delineated their business from that of the grocers, they were required to take an examination to demonstrate their knowledge and ability (1582).

Not only were there greater guarantees in terms of training, the battle against infectious diseases and above all epidemics also became better organized in the sixteenth century. Like Erasmus, Vives argued that doctors ought to be involved more intensively in social medicine, a theme that would gain in importance in the centuries that followed. The duties of the municipal physician gradually expanded. He had an advisory role, was responsible for health care and oversaw the various groups of health workers.

Surgeons were appointed as rode meesters (‘red masters’) during plague outbreaks (1530).

In addition to preventing and diagnosing cases of plague and treating its victims, they were responsible for diagnosing suspected cases of leprosy.

3 Anselmus de Boodt, Florum, Herbarum, ac fructuum Selectiorum icones, & vires pleraeq[ue], hactenus ignotae, Bruges, 1640 Stedelijke Openbare Bibliotheek Brugge ‘De Biekorf’, inv. 2/611 Page 17-18

4 Petrus Smidts, Waerachtigh verhael Raekende eenen steen, die een man ghelost heeft, weghende vier onsen ruijm Medicinael ghewight, …, Bruges, 1698 Stedelijke Openbare Bibliotheek Brugge ‘De Biekorf’, inv. 7/295 VARIA Titlepage 5 Junius De Pre, Oprechten Vlaemschen Tydt-wyser ofte almanach, Bruges, 1683 Stedelijke Openbare Bibliotheek Brugge ‘De Biekorf’, inv. B 226 Titlepage

toad for their supposedly protective or curative value in the face of the epidemic. Surgical treatment did advance somewhat, but it remained limited in the seventeenth century to external interventions. Exceptions included the removal of bladder stones or ‘cutting for the stone’ (Fig. 4) (see J. J. Mattelaer’s article in this book), and a total of six leg amputations in seventeenthcentury Bruges. Despite the rational approach adopted by Rapaert and Vives, belief in astrology remained deeply rooted (Fig. 5). Worse still, superstition and witch trials were rampant. In one instance, Bishop Triest forbade Bruges’s physicians to visit a seriously ill man whom he suspected of ‘the contagious disease of heresy’, unless the patient first went to confession and took communion. It is plain from these examples how dark and difficult social attitudes still were in the two centuries in question. All the more reason, therefore, to admire those voices in the Bruges of that time who called for renewal.

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that a Collegium medicum of this kind actually arose.

stagnation in medical practice While there was a great deal of innovation in the field of medicine in Bruges in the sixteenth and seventeenth centuries, little progress was made compared to practice in previous centuries as far as actual diagnosis and treatment were concerned. Hippocratic Galenism, with its doctrine of the humours, continued to set the standard for physicians’ practice. The population at large – certainly in the countryside – had more to do with barbers and all manner of quacks and charlatans than with learned physicians or practically trained surgeons. The diagnostic tools available to the physician remained largely limited to the superficial and highly subjective determination of body temperature; evaluating the pulse; and visually examining the patient’s urine. Any advance in medical treatment was rendered difficult by the fact that the distinction between symptoms and disease had yet to be

effectively defined, while it was not until the end of the nineteenth century that the cause of infectious diseases was linked to microorganisms. In his 1669 treatise on the plague, for instance, Montanus continued to praise amulets made of precious stones and extract of

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public safety, hygiene and disease prevention Heidi Deneweth

Bruges was a densely populated metropolis by medieval standards, numbering 45,000 inhabitants around 1340 within an area of 430 hectares. When Antwerp took over Bruges’s role in international trade and finance in the late fifteenth century, roughly a third of the population emigrated. All the same, Bruges remained one of the largest cities in the Southern Netherlands in the early modern period, with a population that varied between 25,000 and 38,000 inhabitants. That kind of population density inevitably generated problems in terms of safety, hygiene and health. The authorities could not intervene in citizens’ private lives, but when it came to threats to public safety and health, they imposed mandatory measures, or at the very least issued strongly worded advice. Most of these measures already existed in the late Middle Ages and were merely refined and developed in the early modern period.

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security Medieval Bruges comprised a small number of stone buildings along with numerous wooden houses with thatched roofs. Following some major fires, the civic authorities took action in as early as the thirteenth century to improve fire safety. Thatched roofs were banned, but to avoid imposing significant costs on the population, their replacement was only required during renovation or repair work. Wooden houses were gradually replaced with stone ones, although many retained a wooden facade until the seventeenth century. Road safety was not tackled for the first time until around 1500. In a last-ditch attempt to keep the international trading communities in Bruges, they were offered all the facilities they desired, including a guarantee of a more efficient interface between the harbour and market zones. This entailed clearing away obstacles: protruding porches, cellar entrances,

benches, shop signs and shutters were banished from the main thoroughfares. Building materials were transferred from quaysides, streets and squares to closed warehouses. Even loose pigs, horses, carts and carriages were dispatched from the public to the private space.

clean water The main problems in terms of hygiene were the water supply, drainage and refuse management. The early medieval settlement had drawn its drinking water from the Reie, which was also able to cope at that time with the limited amount of organic waste deposited in it, which it broke down naturally and carried out to sea. By the thirteenth century, however, industrial and residential activities had reached such a scale in the city that the discharge of sewage water and other waste meant the river water was no longer

Carmersstraat

Sint-Clara

Bloedput Groot Vierkant

Eekhoutstraat

Ganzenstraat

6 Five pipes brought clean river water from beyond the city’s boundaries to its centre. An inventory of these moerbuizen was drawn up in the sixteenth century to ensure better maintenance. Source: E. Vandevyvere, Watervoorziening te Brugge van de 13de tot de 20ste eeuw (Bruges, 1983). © Heidi Deneweth; plan by Nico Insleghers, Raakvlak.

7 Joost de Damhouder, La practicque et enchiridion des causes criminelles, Leuven, 1554 Stedelijke Openbare Bibliotheek Brugge ‘De Biekorf’, inv. 1228 De dommage par iectement dehors Chamber pots were simply emptied out into the street until the sixteenth century. Rain then washed the sewage into the city’s canals. The civic authorities put an end to this problem by enclosing the drains below the surface of the road and urging people to clean up in front of their own houses.

fit for human consumption. One ingenious solution was to tap the cleaner

Boeveriepoort

water upriver and to bring it to the city via lead pipes called moerbuizen.

Clean water was taken from the Sint-Baafsvijver as early as the thirteenth century and from the 1380s onward, the external defensive ditches served

Koepoort

as a reservoir. Five water mains distributed clean water from Boeverie-

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50m

straat) and Koepoort (near the Begijnhof) to the surrounding districts (Fig. 6). Only the richest townspeople and significant industrial complexes such as breweries enjoyed private connections to these systems. The majority of the population took their water from stedefonteinen: large, public wells connected to the moerbuizen.

These were, however, vulnerable to accidental or deliberate contamination. For health reasons and to ensure the continued existence of an efficient water supply, the city closed the pipes once a year so that the wells could be emptied to allow easier cleaning and maintenance. Mechanical pumps were too vulnerable to frost and were an easy target for children and vandals, and so public wells were not fitted with them until the latter half of the eighteenth century.

miasmas The problem of refuse management was a

200m

300m

400m

poort, Carmersstraat, Ganzenstraat, Bloedput (at the end of Beenhouwers-

bigger one. Bruges’s streets sloped down toward centrally located channels that served as open sewers. Householders emptied their chamber pots into them from their upper windows (Fig. 7). Offal, manure, rubble and other refuse was dropped by passing carts.

Waste water from houses and stables was channelled directly into the open drains running along the street. Rainwater dripped directly onto the road from the protruding gutters above, further spreading the filth around. Heavy showers would wash most of the refuse away into the city’s canals. Plots adjacent to a wa-

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tercourse could discharge their waste water and even their toilets directly into it. All the refuse in the street attracted loose pigs, dogs and vermin, made the stones slippery and hindered pedestrians and traffic. The refuse that wound up in the canals was only partially carried away: much of it accumulated, forming a hindrance to water traffic.

Worse still was the stench emitted by all that fermenting garbage. Hippocrates had noted the link between fevers and stinking vapours or ‘miasmas’ as far back as antiquity. All manner of evils were ascribed to them until the second half of the nineteenth century, when the true causes of infectious diseases (viruses, bacteria and parasites) were discovered. The civic authorities introduced measures in the late Middle Ages to limit these miasmas as much as possible by keeping streets and waterways clean and optimizing road safety, mobility and hygiene. Intervention occurred at a number of levels: municipal cleaning, raising citizens’ awareness and combating waste.

The channels running along streets were set into the road surface or covered with special stones. Downpipes were added to roof gutters and – like other waste pipes – connected to this system underground. The combination of drains and rainwater pipes guaranteed an effective flow. Citizens were required to install finely meshed filters in their home drains to prevent large pieces of rubbish from entering and blocking the system. The same applied, incidentally, to toilets and drains emptying directly into the canals. Street drains followed the natural slope of the land, leading from several streets via collectors and large, brick-built sewers into the canals. Structures of this kind were recently uncovered during excavations at Verversdijk and the Prinsenhof (Fig. 8). Marked cover stones were installed in the collectors and large sewers in the sixteenth century so that local residents could, when necessary, perform cleaning work and ensure a smooth flow. The canals thus continued to serve as they had in the past as the

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main sewers. To prevent or restrict miasmas, the water was completely drained once a year or twice in the event of a heat wave. The sluices on the Minnewater were kept closed and those at Dampoort opened, allowing the water to flow to the sea. The owners of the adjoining land were required to clean the canal bed level with their homes and have the dirt taken away – a system that remained in force until the end of the eighteenth century.

Separate waste collection existed as early as the fourteenth century: building waste and rubble, for instance, were recycled as filler for public works. Muederaers, meanwhile, transported organic waste to dung heaps by the city walls, where gardeners and farmers could collect it for use as fertilizer. Preventive action also began to be taken around 1500 to deal with the growing volume of waste. The council ordered all citizens to clean their stretch of road each week and to take the rubbish to the municipal refuse heap. Illegal dumping and failure to clean up were severely punished. Fishmongers, butchers and surgeons were obliged to set aside the blood from slaughtered animals and patients who had been bled, so that it could be collected on a regular basis. To avoid losing any of their cargo, the carters had to cover their loads and to proceed carefully to the ‘blood pit’ at the end of Beenhouwersstraat, where they could then dump it all.

The general measures in terms of safety and hygiene dated from the late Middle Ages and were perfected around 1500, the primary goal being to accommodate the international merchant communities. So it was that Bruges came to be praised by foreigners in the sixteenth century as the model of an early Renaissance city, with wide and clean streets.

frequently unknown. Civic authorities in the early modern era exchanged information about the first cases of potentially infectious diseases, so they could take timely precautions. They played an important preventive role by informing the public, quarantining the sick, eliminating potential spreaders of disease and taking additional hygiene precautions. Traders and travellers from infected cities, for instance, were denied entry at the city gates. For their part, Bruges people were summoned by the ringing of the bell to the Belfort, where they were notified about the impending epidemic. That enabled them to take the necessary steps and to remain extremely vigilant about the onset of symptoms among relatives or neighbours.

The Camer van Ghesontheyt (‘Health Chamber’) was founded in 1603, following several outbreaks of plague in the late sixteenth century.

In it, three magistrates, the municipal physician and the municipal surgeon coordinated all the tasks and supervised all health workers during periods of epidemic. Plague victims had to carry white rods when travelling, although in principle quarantine was compulsory. Infected houses were indicated by two crossed rods. To combat infection, bodies were collected at night and buried, following which the house was thoroughly cleaned. The deceased’s possessions had to be destroyed. Even the cesspools of houses struck by plague were specially cleaned before the building could be reoccupied. More information about the rode meesters and the treatment of plague victims can be found in A. Clarysse’s article in this book.

specific measures for epidemics

During plague outbreaks and other epidemics too, the city appointed dog-catchers to round up and kill strays, which were viewed as possible carriers of the disease. Livestock trading was temporarily suspended and food was carefully screened too. Both unripe and overripe fruit and vegetables could not be brought into the city.

Large cities were vulnerable to infectious diseases and epidemics: it remained unclear how diseases arose and how they spread was also

It was not until the nineteenth century that knowledge of pathogens and the transmission

of disease increased substantially. Early modern people did not know about viruses or bacteria, but they knew through observation how certain infections spread. In the eighteenth century the Austrian Habsburg rulers introduced additional, centralized measures to combat the spread of epidemics by means of more stringent quarantine measures and the provision of clear information. A national system of health care only arose in the nineteenth century, following fresh ravages inflicted by epidemics of typhoid (1846–48) and cholera (1849).

8 Large, brick sewers carried wastewater from the street drains via collectors into the canals, which continued to function as the main sewage system. Archaeologists have excavated a well-preserved sewer on the Prinsenhof site, which was also known from written sources, namely a sixteenth-century inventory of Bruges’s sewers (photograph: Raakvlak).

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care of citizens in sixteenth and seventeenth-century bruges Hilde De Bruyne

from the beginning: a survey The rise of the Flemish cities in the twelfth century prompted a population increase that intensified social divisions. The first care initiatives for the needy – preferably their own impoverished fellow townspeople – were taken by the burgher class and the civic authorities. Hospitals – hospitalen, gasthuizen or godshuizen – were founded, the earliest known example in Bruges being Sint-Janshospitaal. This first offered shelter to the sick – but above all to the needy, travellers and pilgrims – around 1150. Wealthy burghers could even opt for lifelong admission as pensioners in return for their possessions.

For the most part, however, poverty was the driver. The Heilige Geesthuis certainly existed in 1231, but is likely to have been caring for the poor in their homes even earlier than that.

Leprosy was considered contagious and incurable and so sufferers had to be removed from the community. The Magdalenaleprozerie is first

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recorded in 1227, but had been caring for lepers (Fig. 9) for years by then. The patients admitted to the Magdalena were well-off burghers. Poor lepers, who were also citizens of Bruges, formed a guild. They lived beyond the city walls but still within its legal jurisdiction. The authorities ordered them to move in the fifteenth century to four plots of land, also outside the city, earning them the name Akkerzieken (‘field sick’). They were permitted to beg. The Hospitaal Onze Lieve Vrouw ter Potterie was in operation by 1276 and, like Sint-Janshospitaal, took in verweecten (the weak), travellers and sick people. It merged with the Heilige Geesthuis in 1300.

Additional institutions began to arise in the fourteenth century for specific target groups, including passantenhuizen for pilgrims, pedlars and travellers, though they were more likely to house the homeless. They were all provided with a night’s free accommodation, sometimes accompanied by a meal. Houses of this kind were mostly located on the outskirts of the

city, on one of the main roads. The Sint-Juliaan house was founded in 1305 by order of the civic authorities and represented the merger of the Guild of St Julian and the Filles-Dieu. The latter was a house dating from 1290 founded as a refuge for former prostitutes in an effort to rein in the sex trade. Sint-Juliaan could accommodate hundred ‘travellers’ in this period.

The rules governing passantenhuizen were tightened in response to the growing number of homeless people. Their raison d’être was sharply reduced therefore by the end of the sixteenth century. Several former hospitals, including the Sint-Joosgodshuis, evolved into passantenhuizen. Travellers continued to be received by major institutions until the end of the French period.

In the early fifteenth century, the Hospitaal Onze Lieve Vrouw ter Potterie developed into an old people’s home for both men and women in need of care. Eighteen elderly women lived there in 1671 and the institution continues to fulfil its ancient function today. The Sint-Hubrechts

liaan and the Magdalenaprozerie were run by lay brothers and sisters, although the rules in operation at Sint-Juliaan resembled those at Sint-Janshospitaal.

Godshuizen or almshouses had certainly begun to appear by the early fourteenth century.

Founded by private initiatives or by crafts or guilds, they were intended to care for needy, elderly citizens. They were the only foundations to spread significantly in the centuries that followed. A remarkable number of almshouses were established in the fourteenth and seventeenth centuries. Forty-two foundations, now disappeared, have so far been identified in the archives, some of which were guild almshouses.

The almshouse complexes that remained at the end of the ancien régime certainly comprised 360 dwellings, of which 45 survive today, still mostly fulfilling the same purpose.

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9 Gradual from the Magdalenaleprozerie. Decorated initial with the image of Mary Magdalene and scenes from her life in the margins, Ghent, 1504.

madhouse was founded by the civic authorities in 1396–97. It housed not only dangerous mental patients but also unplaced foundlings and abandoned children.

At first it was laymen and women who adminis-

tered the different institutions. In the fifteenth century, the brothers and sisters at Sint-Janshospitaal and the Hospitaal Onze Lieve Vrouw ter Potterie adopted the Rule of St Augustine and became a canonical community. Sint-Ju-

A first armendis or ‘Poor Table’ appeared in 1269. These were charitable organizations that provided poor people with material support in their homes, their territory coinciding with that of the parish. Dissen continued to operate in Bruges until as late as 1925.

No facilities were provided for the large group of poor people who were not citizens. One new initiative after another was launched over the centuries to restrict begging, but without success The ideas on centralizing poor relief expressed by the Spanish-Bruges humanist Juan Luis Vives in his 1526 publication De Subventione Pauperum were made law through a decree of Emperor Charles v in 1531. The measures were also intended to reduce begging. The key institutions, including Sint-Janshospitaal, were required to pay substantial sums into the coffers of the Gemene Beurs (‘common purse’) – a central poor relief fund that continued to operate in the centuries that followed. The city used it to pay for things like the subsistence of fostered foundlings, the mentally ill and sick poor people.

A number of cities succeeded in centralizing their care initiatives, but this was not the case in Bruges.

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sixteenth and seventeenth centuries: poor relief, care for the sick?

Sint-Janshospitaal, Sint-Juliaan, the Magalenaleprozerie and Onze Lieve Vrouw ter Potterie remained important care institutions in these two centuries (Fig 10.). Sint-Jan, Sint-Juliaan and the Magdalenaleprozerie admitted sick people.

They performed other functions too.

The city’s burgomasters and aldermen declared in 1569 that Sint-Janshospitaal had been founded to accommodate the sick, the injured, beggars and travellers, from wherever they happened to come. They were to be given a bed, food, care and ‘succoured with medicine and surgery’. Sick people could remain until they had were healed. The ordinance basically reiterated the institution’s mission, with the difference that victims of infectious diseases (most notably plague) were now accepted too.

The stipulation that it made no difference where

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people came from did, however, conflict with the general trend and with later regulations that sought to reserve assistance for Bruges residents, this primarily for financial reasons. The hospital by-laws drawn up in 1598 and approved by the city also specify that the sisters and brothers were to serve the sick and the poor.

Internal regulations on matters like the quality and quantity of food or hygiene (Fig. 11) have not survived, and so our knowledge of the functioning of the hospital is fragmentary. Most of what we know is based on the hospital accounts. Both men and women were admitted, apart from pregnant women about to deliver.

Children were there too, as were soldiers during wartime and foreigners suffering from acute illness. The number of travellers fell off sharply from the sixteenth century. From around 1600, mental patients had to seek refuge in institutions including Sint-Juliaan and were no longer admitted to Sint-Jan. Admission was normally only possible with a certificate from the armendis or the parish priest. Day-to-day figures for the number of sick people are hard to come by. The occupancy rate in 1547–48 was seventy and the hospital employed twenty staff members for hundred beds until the end of the eighteenth century. After the brothers had left, the mevrouwe took over from the master of the institution. She submitted the accounts prepared by the receiver to the civic authorities and reported to the bishop. There were between twelve and fourteen nuns in 1573. The major building work carried out during the two centuries in which we are interested comprised the construction of the convent (1539–1685).

The rekezusters were present on the wards both night and day, admitting patients, helping them undress, caring for the sick and injured, providing a bed to travellers and the needy, distributing food, washing the linen and keeping watch. They also offered their support during a patient’s final hours, when they assisted the priest. They helped bury the dead in the hospital cemetery. There was a spindezuster, the

10 Loving cup with the emblems of Sint-Janshospitaal, Onze Lieve Vrouw ter Potterie, Sint-Juliaan and the Magdalenaleprozerie, the Bruges municipal arms and the city’s crowned capital B symbol.

Around the edge the motto Eendracht mackt Maecht (‘unity is strength’), Bruges,1664. Memling in Sint-Jan – Hospitaalmuseum Bruges 11 Detail of dresser with view of the ward at Sint-Janshospitaal, Bruges, 1678, Memling in Sint-Jan – Hospitaalmuseum Bruges

deputy head of the community, and a female sacristan. The hospital priest provided pastoral care, which was still more important than health care. Four male servants or rekeknapen and a maid were also employed on the ward.

The tasks performed by the medical staff are not specified, although payments and the names of surgeons and doctors appear in the accounts.

Surgeons and barbers were attached to the hospital in the thirteenth century. The surgeon set broken bones, treated wounds, performed amputations and lithotomies, and otherwise eased patients’ maladies. Bleeding, meanwhile, was the task of the barber. A surgeon was paid in the sixteenth century for performing the same task. Physicians diagnosed – by examining the patient’s urine, for instance – and prescribed medication. The growing importance of a doctor’s presence in the hospital was a new feature.

A salaried physician was attached to Sint-Janshospitaal from around 1600, and the number rose to two in the mid-seventeenth century. The sick now had to be visited and examined by a physician on a daily basis. At least two surge-

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ons were attached to the hospital by the midseventeenth century. The names of well-known, innovative medical men appear in the archives.

The role they played in caring for the sick at Sint-Jan can only be inferred, however, from the opening in 1644 of the hospital pharmacy and an operating theatre.

The organization of the main ward by gender remained the same throughout the centuries.

There were no individual rooms, but the space was split into rows or reken, hence the references in the accounts to a mannereke, vrouwereke, noortreke, zuidreke and soldaetereke (men’s, women’s, north, south and soldiers’ row respectively). There was also an infirmerie for

men and one for women, and a doothouc (literally ‘death corner’). Each row comprised an ambacht with its own linen and equipment. The ‘mistress’ was responsible for the linen stock.

Like so many other churches and chapels, the hospital chapel was refurbished in the Baroque style in the seventeenth century, although it remained, according to the medieval principle, an open space visible to the sick. The chapel was not closed off until the nineteenth century.

View of the Old Wards, which the Bruges artist Johannes Beerblock, painted around 1778, depicts the unchanged life at the hospital at the time. It was poverty rather than ill health that drove people to the hospital, with exceptions in-

cluding the wounded who came to Sint-Jan for the medical care it offered.

Leprosy was present for centuries in Flanders too, although there are few local sources describing the disease and its treatment. It was considered to be highly contagious and so people designated as lepers were no longer permitted to take part in the life of society. They were placed in a leper colony or shared the lives of the Akkerzieken. The incidence of leprosy began to decline steeply in the sixteenth century, and by the beginning of the seventeenth it had all but disappeared. The Magdalenaleprozerie was located beyond the city walls. This first leper hospital in Bruges is shown in several sixteenth-

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century maps. It was situated at a distance from the city, between Boeveriepoort and Smedenpoort, and separated from it by a watercourse.

There was accommodation for the brothers and sisters, the church, the priest’s house, utility buildings and, as at other leper hospitals, small, individual leper houses. The latter were built in a row, separated by a small garden wall, and had front and back rooms. The total number is not known. The lepers had their own chapel and well, and their dead were buried in a separate cemetery.

The governors – representatives of the civic authorities – took most of the decisions and managed the hospital’s affairs. The lay community comprised the master, the receiver and lay brothers and sisters, who were well-to-do burghers. The master was appointed by the city council. He was responsible for the orderly running of the institution and for day-to-day purchases. To qualify for admission to the Magdalenaleprozerie, the patient had to be a welloff citizen and to have officially been declared a leper. Patients could also pay for admission, in return for which they received board and accommodation. When they died, their immediate possessions and a substantial part of their estate was inherited by the institution.

The old leper colony was demolished in 1578 for military reasons, at which point it relocated to the city centre, in part of the Onze Lieve Vrouw van Nazareth complex – a fourteenthcentury passantenhuis on Garenmarket. The foundations were merged by deed in 1590, with the master of the Magdalena taking charge of the ‘comfort of the poor’. The names of the two institutions were preserved and both appear separately in the general annual accounts. The hospital continued to receive lepers, travellers and other gasterie ‘in separate places as far apart as possible’. The deed indicates that there were no longer many travellers or paupers. The leper hospital restored the existing chapel and houses of the passantenhuis staff. The 1617 accounts record payments for the construction

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of a new hospital wing. The same date can be seen in the anchor plates in the wall of the surviving building, alongside the fifteenth-century chapel on Nieuwe Gentweg. The Akkerzieken also settled inside the city in 1578 for the same reason, taking up residence in a house on Oude Gentweg. Only six of them were left in 1572 and the last one died in 1618.

The Magdalena was one of the three principal leper hospitals in Flanders, together with those in Ghent and Ypres. They each had the task of monitoring the presence of leprosy within a clearly defined area. Inspections to certify who was and was not suffering from the disease were performed in Bruges by the master, the brothers and the sisters, who were paid for these visitaties. It is not clear whether a doctor or surgeon was also present in the sixteenth and seventeenth centuries. The record of these examinations for the period 1520–55, kept by the master, states the potential leper’s name and address and then the bald conclusion ‘healthy’ or besiect (‘infected)’. The basis of the diagnosis has not been found in either the institution’s rules or the municipal by-laws, unlike in Ghent. The aforementioned sixteenth-century register – seemingly the only one to have survived – records a total of 2,464 examinations over a 35-year period, 23.5 percent of which resulted in diagnosis as lepers. Of these, 139 of the patients were Bruges people. Admittance to the leper hospital was made official by a certificate issued by the civic authorities and was conditional on the patient being free of debt. The Akkerzieken were also subject to examination and municipal certification.

There were an average of 21 patients at the Magdalenahospitaal in the period 1530–39.

Leprosy cases began to decline in the midsixteenth century, so by the time the institution relocated in 1578 there were only ten remaining lepers. It was not until the accounts for 1741, however, that it was recorded that no lepers were residing any longer at the Magdalena. The hospital’s importance thus having diminished,

it was given a new municipal function in the eighteenth century, becoming a house of correction in 1752, although its tasks still included accommodating travellers and the occasional leper. The Magdalena was closed down during the French period.

Toward the end of the fourteenth century, the city purchased a house on Boeveriestraat to care for a small number of mentally ill people who posed a danger to society, and for unplaced foundlings and abandoned children. A set of rules for Sint-Hubrechts, as the institution was known, was drawn up by the civic authorities in 1596 and states that the madhouse was run by a warden or concierge under the supervision of the city and at its expense. His task was merely to oversee the patients who were poor citizens of Bruges, designated as such by the city. The warden was responsible for locks and shackles ‘that the aforementioned might not break out’, for cleaning the cells and replenishing the straw. He was to feed them three times a day with bread and butter and thick soup (potage).

The city paid for the patients’ clothes and for wood to heat the house. The warden was also required to accompany the patients and the children in the Holy Blood Procession.

The institution was financed through foundations and collection boxes set up at important locations like the entrance to the Basilica. It was supervised by the master of Sint-Juliaan. The same rules defined the status of foundlings and abandoned children. They were children whose parents were unidentified; otherwise every effort had to be made to reunite the child with them. The warden’s wife was responsible for their care.

The residents of Sint-Hubrechts ten Dullen – five paying guests, mental patients, were transferred in 1600 to Sint-Juliaansgasthuis, which was located on the opposite side of Boeveriestraat. The Sint-Hubrecht buildings came into the possession of Gerard and Herman van Volden, who established an almshouse in them in 1614. Sint-Juliaan adapted its buildings,

erecting two dulhuusekens (‘madhouses’). The aldermen stated in their ordinance of 1600 that they retained ultimate authority over Sint-Julian and that the hospital was to ‘receive and lodge all needy travellers and pilgrims, men, women and children.’ Sint-Juliaan was also charged with the care of the mentally ill poor citizens – both men and women – , foundlings and abandoned children. The lay community was not to exceed seven brothers and sisters and responsibility lay with the master (Fig. 12), who was to supervise and administer the institution.

The admissions procedure specifies that the master was to examine the mentally ill people: the document makes no reference to a doctor or surgeon being present. The patients’ financial situation was also examined. The master wrote a report and submitted it to the city council, which then took the final decision. Patients with less acute conditions, which was the majority, could be tended at home, for which they received an allowance. They could also be admitted to a non-municipal institution or placed in Sint-Juliaan. The master was to receive the sick ‘with all compassion and sympathy’ and was to take care of chains and locks. Their food was to be the same as that given to other residents.

In the event of a cure, following examination by the governors and the clerk of the municipal court, all the patient’s possessions passed to Sint-Juliaan. The same ordinance specifies that all foundlings and abandoned children were to be fostered. It was the master’s duty to arrange this and to inspect the new home, with the council giving permission for the placement.

Funding was provided by the Gemene Beurs. It was chiefly widows who took in one or more children. Some of them attended the school for the poor, while others were set to learning a trade.

ber rose in the course of the eighteenth century.

It was only toward the end of that century that salutary care for mind and body gradually developed into health care as such, as clearly reflected in hospital life. The development of medicine only began in earnest in the mid-nineteenth century.

Anonymous, Portrait of Jan De Herdt, Master of Sint-Juliaan. Detail with view of the former SintJuliaanshospitaal, Bruges, 1650.

There were seventy-six fostered foundlings and abandoned children in 1654. A total of fiftheen sick people were admitted in 1610, which is a high number given the target of eight. An average of nineteen mental patients were resident at Sint-Juliaan between 1654 and 1674. The num-

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care providers in the sixteenth– seventeenth century Michel Deruyttere

The different groups of health professionals were increasingly structured in the sixteenth and certainly in the seventeenth century, and their training became progressively more sophisticated. Barbers and surgeons belonged to the ‘Beardmakers’ guild; they were citizens of Bruges, craftsmen and artisans. Their charter – drawn up between 1507 and 1607 – comprised 49 ‘points and articles’, setting out the rules and guidelines for membership, function and ethics.

The parchment roll is nowadays preserved at the Rijksarchief in Bruges. The surgeons were united religiously in the Guild of Saints Cosmas and Damian. Their guild chapel was in SintJakobskerk, where their patron saints can still be admired in the painting they commissioned from Lanceloot Blondeel.

Unlike the physicians, surgeons did not know Latin and they learned their trade as apprenti-

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ces to an established master. They focused exclusively on the ‘outside’ of the body, their work consisting chiefly of the treatment of wounds and abscesses, bleeding on the instruction of a physician, splinting fractures and, if necessary, amputation. Skilful barbers would not only cut their customer’s hair and shave their beards, they also offered to bleed them. The surgeons formed their guild, the ‘Neringhe der Chirurgijns’, in the seventeenth century, publishing their charter – which can also be found in the Rijksarchief – around 1665. They met at the ‘School voor Chirurgie’ in Het Steen on Burg square, where would-be surgeons were also trained. It was for the latters’ benefit that Jan Pelsers wrote his popularizing Examen chirurgorum in 1565. The treatise, which can now be seen at the Biekorf in Bruges, was subtitled ‘clear education, plainly written and unadorned,

for surgeons and barbers’. In 1569, the Bruges printer Pieter de Clerck published Dat epitome

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dent intellectuals from a higher social class who knew Latin and had completed medical training lasting an average of five years at Leuven University (1425) or other established universities like Douai and Rome. Those who trained in Bologna, Padua or Basel were required to sit an entrance examination before setting up practice in Bruges. Physicians were concerned with internal complaints – their patients’ ‘insides’ – and were members of the Guild of St Luke (Fig. 13). Their knowledge still relied primarily on the teachings of Hippocrates and Galen: the discoveries of Vesalius, Harvey and Van Leeuwenhoek only filtered through very slowly.

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ofte cort begriip der anatomien – an abridged version of Vesalius’s masterpiece De humani corporis fabrica.

The civic authorities introduced a surgery examination toward the end of the sixteenth century. The municipal accounts for 1631 state that Dr Jan Vekemans was paid a fee for providing lessons in anatomy, while an Anatomie-Camer was set up at Het Steen in 1675. The first dissection was performed on 6 February 1675 in the presence of the entire medical corps and the city’s magistrates, dignitaries and students.

The event was commemorated in a painting by Filip Bernaerts (now in the Memling Museum at Sint-Janshospitaal, Bruges). Students were allowed to practise after training for three to four years under a recognized surgeon and passing an examination. Most of them did so privately, announcing their surgeon’s shop by means of a painted sign out front. In some cases they shared their practice with a barber, as we see in Egbert van Heemskerck’s painting, The Barbershop (Ghent). Two surgeons – appointed by the city council – were attached to Sint-Janshospitaal. That number did not increase until the eighteenth century.

The gulf between surgeons and physicians or doctors was still a huge one in the sixteenth– seventeenth century. Physicians were indepen-

Montanus (Fig. 14) – Bruges’s leading seventeenth-century physician – called for a rapprochement between surgeons and doctores medici, convening a general assembly of the two groups at the Poortersloge. His initiative, recorded in a painting by Bernaerts, proved a failure, however. It was not until 1760 that the Collegium Medicum was established, comprising representatives of the civic authorities, doctors, surgeons and pharmacists.

In addition to the ‘established’ surgeons, there were itinerant and frequently skilful lithotomists (see J. J. Mattelaer’s article in this book), but also quacks and tooth-pullers who travelled from town to town armed with all sorts of fake diplomas, living off the community. To combat malpractices of this kind, Emperor Charles restricted the practice of medicine to universityqualified doctors. The criteria for accreditation as a physician, surgeon or pharmacist were published in a decree dating from 18 October 1524. Montanus founded the Guild of St Luke in 1662 in order to better defend the profession.

Grocers and pharmacists belonged to the ‘Neeringhe van de Cruydhalle’. The civic authorities drew up a prescription book in 1557, followed in 1582 by a municipal ordinance stating that no one was permitted to open an appotecaire winckle without first undergoing three years’ training. The requirement was subsequently

raised in 1632 to as much as five years. Dr J. Vanden Zande compiled the first Pharmacopeia Brugensis in 1697. Although this was approved by the appointed commission, it met with intense opposition from the pharmacists themselves.

Health care became increasingly structured.

Poor people, pilgrims and travellers were cared for by the nuns at Sint-Janshospitaal, while the burghers of Bruges were tended at home by Alexian Brothers and Sisters – members of a lay order devoted to caring for the sick. Midwives formed a separate group of carers, with their own status and ethics. The city council instituted a ‘midwives’ oath’ in 1551 to curb proliferation of malpractice. They were admitted to the profession after three years of training and examination by ‘learned physicians’, following which they were allowed to display a pelvis symbol or white cross outside their house. Deliveries occurred at home. To improve midwives’ training, Cornelis Kelderman of Bruges published a manual in 1697 entitled Onder-wys voor alle Vroedvrouwen.

13 Anonymous, Miracle painting, on canvas, Meetkerke Church, by Gillis Janssins, 1645. An inscription at the bottom states that ‘a doctor’s wife in Bruges was cured in childbed from a deadly disease by invoking Mary of Meetk[erk]e’.

14 Jacob van Oost (1639-1713), Portrait of Thomas Montanus, painted on canvas, Stad Diksmuide

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medical books published in bruges Ludo Vandamme

Books are a mirror of society. In this essay, we offer a brief survey of the books produced by the medical world in Bruges in the sixteenth and seventeenth centuries. Without seeking to be exhaustive, we look in turn at medical astrology, work by surgeons and physicians, and government publications. The focus is on both the work of locally based authors and the medical output of printer-publishers. The publishing business in Bruges was modest in the centuries in question and so authors in the city frequently entrusted their texts to printers in Antwerp or abroad. Sixteenth-century book production in the Low Countries was recently estimated at about 30,000 editions, of which Bruges can lay claim to barely a hundred. The situation did not differ much in the seventeenth century.

Almanacs and astrological forecasts were the tool par excellence of practical medicine. The astrological calendar was crucial to surgeons when it came to performing (pseudo-)medical procedures like bleeding, cupping and administering medication. It is quite possible that almanacs were published each year in Bruges in

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the final quarter of the fifteenth century, but no such material has survived. All we know is that Colard Mansion – a printer who was active in Bruges between 1476 and 1483 – published an almanac in French for the year 1478. Fragments of a copy turned up in the nineteenth century, but subsequently disappeared again without trace.

Bruges physicians were particularly assiduous in composing astrological forecasts in the sixteenth century. Pieter Bruhesius (died 1571), the municipal physician, was responsible for the official almanac, which other local physicians like François Rapaert (died 1587) and Cornelis Schuute (died 1580) condemned as unscientific. Rapaert responded with his own eeuwigen almanach (‘perpetual almanac’, 1551), while Schuute championed the annual forecasts that he published himself. Whatever the case, doctors in Bruges did not have their forecasts published – whether in broadsheet or book form – in their own city, but in Antwerp. It was not until well into the seventeenth century that regular almanac production got under way in Bruges.

The earliest surviving example – and another one-off – is the Oprechten Vlaemschen tydtwyser (‘Honest Flemish Almanac’) for 1683. The medical instructions are still there, although the compiler is no longer a physician but a mathematician.

Surgeons were firmly rooted in practice, and so their publications take the form of training manuals and concrete guidelines on dealing with epidemics in the city. One excellent surgical manual is Examen chirurgorum by Jan Pelsers (died 1581). He also addressed his fellow practitioners – chirurgienen ende barbiers – in the vernacular. That book was published in 1565

by Hubertus Goltzius’s private press: part of a humanist circle in which Pelsers clearly felt at home. A new edition subsequently appeared in the Northern Netherlands in the seventeenth century (Fig. 15).

Pelsers drew on his many years of expertise as a ‘plague master’ in Bruges for his volume Van de Peste (‘On Plague’), which Pieter de Clerck published in 1569. The plague books of the

surgeon Gheeraert van Kuck are older, but he gained his experience of the disease in Spain in 1518, within the entourage of Charles v. It was only later that he worked as a surgeon in Bruges, which he continued to do until 1531.

His twin plague treatises were published in Antwerp later still, perhaps posthumously. Despite the changes in the city’s fortunes, Van Kuck was still described as ‘a surgeon of the celebrated trading city of Bruges’. Outbreaks of plague in Bruges continued to prompt books of this kind in the seventeenth century. It was a physician for once, Thomas Montanus (died 1685), who in 1669 turned his journal on combating the plague of 1666 into a comprehensive Latin treatise entitled Qualitas loimodea sive pestis Brugana, published in Bruges by Lucas vande Kerchove.

Bruges-based printers continued to publish work by local surgeons – compact, practical books in Dutch. A typical example is Het Kortverhael van den loop soo vanden chyl als ’t bloet (‘Concise Account of the Flow of Both Chyle and Blood’) by the surgeon Pieter Lanbiot (died 1728), published by Pieter van Pee in 1688. In it, Lanbiot offered ‘the fruits of seventeen years obtained with the dissecting knife and gathered together’.

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15 Jan Pelsers, Examen chirurgorum (Dordrecht, 1612), with provenance from Cornelis Kelderman.

Stedelijk Openbare Bibliotheek Brugge ‘De Biekorf’ inv. 2/536c Title page

In its rise to the status of a critical, ‘modern’ science during the sixteenth-century Renaissance and the seventeenth-century scientific revolution, medicine made very little use of the publishing industry in Bruges. All the same, the city was not entirely unemployed. Cornelis van Baersdorp (died 1565) from Bruges and Willem Pantin (died 1583) from Tielt practised medicine out of a broad, humanist interest, with considerable respect for Galen and other ancient auctoritates. Van Baersdorp’s Methodus universiae artis medicae offered a general introduction to Galenic medicine. The Bruges printer Hubrecht de Croock published it in 1538 – the first medical book to be printed in Bruges. Van Baersdorp was active in the years in question as a personal physician in the entourage of Emperor Charles v and his family, before settling permanently in

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Bruges. In 1551 Pantin was appointed physician to the city. He produced a meticulous and thoroughly annotated edition of De medicina – Aulus Cornelius Celsus’s first-century medical treatise, for which he turned to Johannes Oporinus in Basel (1552), one of Europe’s leading printing works.

The ‘new’ medicine went further, however, than the critical study of examples from antiquity. Vesalius and his anatomical study (De humani corporis fabrica libri septem, 1543) set out the possibilities of empirical research. The Fabrica’s influence was immense, not least through Vesalius’s own manual (Epitome).

The Bruges physician Maarten Everaert and Jan Wouters (died c. 1597) – a young doctor working in the Zeeland town of Veere – independently produced Dutch translations of the Epitome.

Everaert worked on behalf of Christophe Plantin in Antwerp, who published the book in 1568. Wouters had to make do a year later with Pieter de Clerck’s more modest press in Bruges.

Jan Pelsers, to whom Wouters dedicated his translation, is likely to have been behind this Bruges connection.

The scientific revolution gathered momentum in the seventeenth century. Bruges physicians translated the new insights into a mechanistic, Cartesian image of the human body for a wide audience. Robert Maes (died 1700) did so in his Tractaet van de voortkomste ende generatie des mensch (‘Treatise on the Origin and Generation of Man’, published by Jan de Grieck in Brussels, 1689). Robert Maes and several others of his Bruges colleagues engaged uninhibitedly in the battle against bleeding and other traditional medical practices, which doctors were now keen to consign once and for all to the past. The vernacular work did, however, find its way to a printing press in Bruges.

16

16 Cornelius Kelderman, Midwives’ training manual.

Stedelijke Openbare Bibliotheek Brugge ‘De Biekorf’, inv. B 57 Title page

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Throughout the period, Bruges’s civic authorities kept a close eye on public health and the medical sector in the city. The ordinances and by-laws laying out this policy in concrete terms – especially during plague outbreaks – were increasingly disseminated in printed form in the seventeenth century, to which end local printers were naturally used. The same goes too for the more comprehensive works in which the magistrates were involved. Examples dating from 1697 include the midwifery textbook (Onderwys voor alle vroedvrouwen) by the Bruges municipal surgeon Cornelis Kelderman, printed by Ignatius van Pee (Fig. 16), and the Bruges pharmacopoeia (Pharmacopoeia Brugensis) by Johannes Vanden Zande, printed by Christoffel Cardinael.

the emergence and disappearance of infectious diseases in bruges in the sixteenth and seventeenth centuries Johan R. Boelaert

Figure 17 shows the timeline of several major infectious diseases that afflicted Bruges between 1200 and 1900. Two new infectious diseases – syphilis and sweating sickness – emerged in sixteenth and seventeenth-century Bruges, while two other prominent diseases – leprosy and plague – faded from the streetscape. We will focus first on these four diseases.

Syphilis is a sexually transmitted bacterial disease that appeared in Bruges in 1496 and represented a serious health problem in the sixteenth century. It probably did not occur in Europe prior to that date, but was brought to Spain by the discoverers of America. Spanish soldiers were then infected via prostitutes and spread the disease in the same way to other soldiers during a French-led campaign in Italy in 1494–95. Mercenaries from all over Europe

were involved in that conflict in two opposing coalitions. Many of them were infected with syphilis, which they spread to people in their home regions on their return. The disease had several names, including the ‘French disease’ and the ‘Spanish pox’. A Bruges by-law documents its first appearance in the city in 1496.

Syphilis manifested itself in the early part of the sixteenth century as a severe infection with pronounced pain, deformities and in many cases a rapid progression to death. It later took on a milder form. Several contemporary theories were put forward concerning the origin of this degrading condition. Maximilian of Austria saw it as God’s punishment for blasphemy; scholars in the Low Countries attributed it to an exceptionally unpropitious alignment of the planets a few years earlier; while a Bruges notary public stated that the cause lay in drinking wine

mixed with the blood of lepers. All the same, the disease did help advance medical thinking.

It quickly became apparent that the condition was spread through human contact. The Italian physician Girolamo Fracastoro speculated about the existence of invisible ‘spores’ of disease, predating the emergence of germ theory by more than three centuries. The time was not yet ripe, however, for his ideas. There were new therapeutic developments too, as doctors began to compare the merits and drawbacks of two types of treatment – mercury and gaiacum wood.

Unlike syphilis, sweating sickness, which broke out in Bruges in 1529, was not an entirely new disease. Two epidemics had already occurred in England a few decades earlier before a third outbreak there spread to the continent, infecting Bruges among other places. The condition was

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Leprosy Smallpox Scrofula Tuberculosis Malaria Dysentery Gonorrhoea 1349

Plague

1669

Syphilis

1495

Sweating sickness

1529

Influenza Cholera

1100

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1200

1300

1400

1500

1600

1700

1800

1900

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transmitted incredibly quickly, with 300 people in Bruges dying within 24 hours of the first symptoms appearing. Although the cause was almost certainly an infectious disease, the microbial origin has never been identified. Interesting aspects of sweating sickness include the treatment that was applied and the proposed devotional response. Medical treatment was based on the ancient theory of the humours and sought to drain off the poison of the disease and to relieve the patient’s fever via their sweat. This sweat cure was achieved by keeping the patient warm in bed as soon as the first symptoms manifested themselves. As part of the religious response, the ecclesiastical authorities commissioned a small book from the Bruges humanist Juan Vives as an invocation against the disease and to encourage the population to venerate the Sweat of the suffering Christ. The approach is illustrative of two principles that frequently applied at the time: that of analogy (the Sweat of the Redeemer and that of the patient) and that of complementarity between the medical and religious aspects of disease prevention and treatment.

Other infectious diseases faded into the background in the seventeenth century. Leprosy was considered a health priority in the twelfth and thirteenth centuries, as witnessed by the large number of leprosaria or leper hospitals that were founded in this region, including the Magdalenaleprozerie to the west of Bruges. The in-

cidence of leprosy, however, began to reduce in the second half of the sixteenth century. When the Magdalenaleprozerie was demolished by order of Philip II in 1588 for military reasons, ten lepers were transferred to the Onze Lieve Vrouw van Nazareth hospitce on Garenmarkt.

For reasons that remain unclear, leprosy died out in Flanders, Bruges included, in the latter half of the seventeenth century. It might have been linked to the rise during that period of tuberculosis, which has a great deal in common, biologically speaking, with leprosy.

Another infectious disease – and a major one at that – that disappeared from everyday life in the second half of the seventeenth century was the plague. Since its brutal appearance in 1349, known as the ‘Black Death’, plague epidemics had returned with a degree of regularity.

Especially large epidemics were witnessed in the sixteenth century, with reports of plague in Bruges in about 29 different years throughout the century. There were fewer outbreaks in the seventeenth century and the plague disappeared from Bruges following the well-documented epidemic of 1666. The disease not only vanished from the streets of Bruges, but also from other cities in the Southern and Northern Netherlands and in England – all within the span of just a decade, between 1669 and 1678. The reason for the simultaneous disappearance of plague in north-western Europe has never been explained. Climatic factors, such as higher tem-

peratures; biological factors like a shift within the rat population or the reduced virulence of the plague bacillus; and improvements in hygiene have all been cited as possibilities.

In addition to these two new infectious diseases and the two that vanished, other diseases underwent changes in the two centuries in which we are interested. We will restrict ourselves to three examples. Diphtheria or ‘croup’ was first reported in Europe in the late sixteenth century, yet we know of no seventeenth-century references to the disease in Bruges. Two very old diseases – smallpox and tuberculosis – intensified in the late seventeenth century and beyond.

Even less is known about the pattern of influenza or flu in Bruges, as the disease had not yet been recognized or designated as a separate entity. We have grown used in the twenty-first century to the appearance of new infectious diseases: the first cases of HIV infection and AIDS, for instance, emerged around 1980.

17 Timeline for several major infectious diseases in Bruges between 1200 and 1900. The solid lines indicate the proven presence of a disease, while the dotted lines show periods in which there were almost certainly sporadic or endemic outbreaks of a disease in the city, but for which the Bruges archives do not offer firm evidence.

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the plague in bruges Albert Clarysse

The Bruges region had to endure regular plague epidemics, interspersed with sporadic deaths from the same disease, between the panEuropean Black Death of 1347 and 1669. The civic authorities responded in the late fifteenth century with an increasing number of measures. All waterways and wells were cleaned, stray dogs killed and infected houses marked. Infected people and those who cared for them were quarantined. An official was appointed in 1563 with the task of registering infected houses, and pesthuysen were set up on Magdalenaveld in 1602, to which plague victims could be brought.

A ‘Health Chamber’ (Camere van Ghesontheyt) was founded in Bruges in 1603, following the example of several other European cities. This

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took a number of measures to combat the spread of the disease and to ensure the proper

care of plague victims. It is evident from these measures that the powers-that-be realized that

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18 Proclamation on the plague issued by the civic authorities in Bruges on 25 August 1625 and reissued on 20 May 1666 Stadsarchief Brugge 19 Earliest necrology (period 1632–63), panel, monastery of the Discalced Carmelites, Bruges The Discalced or ‘Barefoot’ Carmelites tended to plague victims, at the cost in some cases of their own lives.

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the disease was contagious. The steps taken by the civic authorities may have contributed more to the control of the disease than the treatment offered by physicians (Fig. 18). The latter were unaware, after all, of the existence of bacteria, believing instead that plague was caused by a toxin supposedly created in decomposing food, plants, excrement or corpses. They proposed various measures to prevent the formation of plague toxin, to neutralize it or to prevent contact with it. If contact occurred nevertheless, a variety of means were proposed to raise the patient’s resistance or to remove the toxin by inducing sweating, vomiting and/or diarrhoea.

Two Bruges physicians – Jan Pelsers (1569) and Thomas Montanus (1669) – published books describing their experiences during plague outbreaks. At the end of the day, doctors did not play a leading role in this respect: their role was more of an advisory one.

Treating plague victims was entrusted to rode meesters (‘red masters’), so-called because of their red upper garments. These surgeons were well paid and received free accommodation and clothing, a horse plus feed, and a male or female assistant. Their task was to visit the

marked houses and to confirm the infection. The rode meesters also had to get plague victims to transfer to the plague houses and, once the outbreak was over, to declare their homes ‘pure’.

They treated patients’ buboes and distributed medicines. Buboes were cut or burst with a redhot iron or with hot wax dripped from a candle.

According to Montanus, placing the anus of a live chicken on the bubo was an effective treatment. Highly complex mixtures of herbs, minerals and other materials were prescribed, as if in the hope that the myriad of ingredients would include something that might prove beneficial.

Plague was seen as a punishment from God: people were exhorted to seek salvation in penance, acts of charity, attending plague masses, penitents’ processions, prayer and veneration of plague saints. Religious counsellors provided spiritual texts. Numerous saints were invoked against the plague: we find images of them in paintings, sculpture and reliquaries in churches, monasteries and in the streetscape.

During the epidemic of 1666, the civic authorities recognized St Francis Xavier as Bruges’s special plague saint. The plague was at its most intense in 1631 and 1632. The Discalced or ‘Barefoot’ Carmelites, who had only been present

in Bruges for six months, spontaneously offered their assistance to plague victims, costing nine of these mendicants their lives (Fig. 19).

Estimates vary as to the number of deaths during the various plague epidemics in Europe, although we do have reliable figures for the final outbreak in Bruges in 1665–66. Brother Pieter Van den Driessche – the clerk of the Camere van Ghesontheyt – meticulously recorded each death, together with the date and the victim’s address. Dr R. Pannier concluded from a study of this material that 35% of those infected (1,338 out of 3,795) died, and that total mortality amounted to roughly 4% of the population as a whole (1,338 out of approximately 32,300 residents). Two parishes – Sint-Anna and SintGillis – were the worst affected. As usual, the largest number of cases occurred in the poorer districts, especially during the summer. Mortality was greatest among children (51% compared to 27% for woman and 22% for men). Mortality in Bruges was clearly less severe than that in other countries and regions: Europe’s last plague epidemic in Marseille in 1720–21, for instance, is believed to have cost the lives of half the population.

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cutting for the stone in seventeenth-century bruges Johan J. Mattelaer

bladder stones and lithotomists The presence of stones in the bladder is associated with a wide range of complaints, causing patients acute pain and severe difficulty in urinating (Fig. 20). Bladder stones are especially prevalent in times of poverty and malnutrition, with a diet low in protein – especially meat or fish – as was the case in the seventeenth century. There is evidence in Flanders from as early as the tenth century of barber-surgeons operating to remove bladder stones. We know that Count Arnold the Elder (919–964) suffered from a bladder stone and consulted a number of lithotomists, but that fear ultimately prevented him from going through with the procedure.

Many ‘cutters for the stone’ travelled from town to town: only later did larger cities appoint their own ‘sworn lithotomists’. These travelling surgeons sometimes gave themselves elaborate titles: many were simultaneously steensnijder ende oculist (cutter for the stone and optician) or threw in obstetrics too (steensnijder, oculist ende woutmeester) or even steen ende houtsnijder, oculist en woutmeester (cutter for the stone and wood, optician and obstetrician). In

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response, surgeons’ guilds and civic authorities in Flanders began to supervise and regulate the activities of itinerant lithotomists. Numerous bylaws were announced in this regard from the seventeenth century onwards.

The surgical method for removing a bladder stone changed little between the Roman era and the late sixteenth century. Two assistants gripped the patient’s legs as he sat on a table (known in Flemish hospitals to this day as the steensnedeligging or ‘stone-cutting position’).

The surgeon inserted his left index finger into the patient’s anus in order to feel the stone and to press it downward against the perineum (Fig. 21). A probe held by a third assistant was inserted into the patient’s ureter. The surgeon made an incision in the perineum below the

anus until he made contact with the stone. The incision was then dilated and the stone removed by forceps. The procedure was performed with no anaesthesia other than a little alcohol and a sponge impregnated with mandrake solution.

The most common postoperative complications were bleeding and infection, and also fistula formation, where the wound did not close and the patient continued to lose urine through the opening.

cutting for the stone in bruges The earliest known lithotomy in Bruges was performed in 1270 by Pierre dou Leene, li maistre le tailla (‘master cutter’) on a certain Jan vander Beurse. The lithotomist was assisted by his son, by Maistre Simons, le mire de Bruges, and

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20 Bladder stones. Personal collection 21 The Celsian method (named after the Roman surgeon Celsus) for removing bladder stones according to Tollet and Frère Jacques de Beaulieu: the left index finger inserted into the patient’s anus presses the stone downward against the perineum, where the right hand is ready to cut it out.

22 ‘The undersigned hereby consents to the cutting of the stone from my son Joosep de Pan, Bruges, 8 September 1686 – Joos de Pan’ A father’s consent for a lithotomy procedure for his child.

Stadsarchief Brugge 118 Resolutieboek 1683-1685, p.109.

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Maistre Watiers d’Ipre, physician. The Bruges municipal archives record the modest sum that master Jan Arras was obliged to pay as early as 1340–41 in return for citizenship of the town and the right ‘to cut for the stone’.

In 1595, the lithotomist Jan van den Vyvere, ‘Bruges born’, removed a bladder stone from Clayken Vinchon, ‘aged three years and three months, [who] had long been afflicted by a stone in his bladder, such that when the child made or passed water, he suffered very great pain and distress, this to the great sorrow of the deponents and all other persons who witnessed it ... [Van den Vyvere] cut a remarkable stone from his bladder and did so in such a short time that little blood was lost, to the wonder of many people there present; and he laboured further with good medicines such that he consolidated, closed and treated the wound, so that the child no longer suffers any pain from the stone; but now on the contrary is strong, fresh and healthy in body, and can make and pass water as if he had never been tormented by a stone.’

bruges in the seventeenth century In 1634, the Bruges surgeon and lithotomist Jan Rullens was paid 16 pounds for cutting for the stone in three children and dealing with hernias in five others. The talented surgeon later

moved to Utrecht, but Bruges was able to lure him back with the promise of a two-pound fee for every lithotomy or herniotomy he performed on the city’s behalf. A similar sum was paid in 1645 to Rullens’s son Laurent, who presumably learned how cut for the stone from his father, preserving the secrets of the trade, as was customary. The Bruges municipal accounts for 1666 record the payment to the city’s official lithotomist, Master Descamps, of 50 guilders for one lithotomy and over 24 pounds for similar procedures performed on poor children. The

were performed on males and 87% on patients under the age of 12 – no less than 40%, indeed, on children under five. The number of lithotomies performed in Bruges peaked in the latter part of the century, when a multitude of people consulted Thomas Montanus. We concluded from our study that bladder stones were much more prevalent then they are today and that the principal sufferers were children.

A permit had to be obtained from the civic authorities before the procedure could be perfor-

22

present author, together with Robert Pannier (1927–1995), carried out a study of the city’s Resolutieboek in the seventeenth century. We learned that at least 611 lithotomies were performed in Bruges between 1600 and 1700 – an average of over six a year. This is a minimum figure, as similar procedures performed in the homes of wealthier citizens were not paid for by the civic authorities and so their number was not recorded. Of these 611 lithotomies, 94%

med. Parental consent was required if the patient was a child, that of the patient himself or the next of kin if he was an adult (Fig. 22). These permissions are invariably documented as consent snijden or consent snijden steen (‘consent cutting (stone)’). We noted that from 1696 the permit also began to include the phrase met het versoeck en de wens dat het goed en wel vergaen mag (‘with the request and the wish that it go well’). The system can be viewed as an early

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23 Theodoor van Loonen (1620-1701), Frère Jacques de Beaulieu (16511714), inv. P00791, Rijksmuseum voor de Geschiedenis van de natuurwetenschappen en van de geneeskunde ‘Museum Boerhaave’, Leiden He holds in his right hand the catheter that was needed to identify the location of the stone in the bladder via the ureter. On the table to his right we see the scalpel, two spoons to remove the stone and forceps.

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example of what we nowadays call ‘informed consent’. Prominent citizens or other surgeons were sometimes called on to verify lithotomy requests. We found no references in the seventeenth century to the alms-giving or charity that used to feature in previous years.

Between 1650 and 1700, half of the operations were funded by the city because the patient or his or her parents were too poor to pay. All poor children, soldier’s children and orphans were operated on at the city’s expense. Foundlings, poor and neglected children, and orphans were treated at Sint-Juliaanshospitaal, the master of

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which generally paid the doctors’, surgeons’ and pharmacists’ fees. The names of physicians and surgeons from Sint-Janshospitaal are therefore found in the accounts for Sint-Juliaan.

Study of the Resolutieboek also enabled us to draw up a list of the twelve lithotomists and four surgeons who cut for the stone in seventeenthcentury Bruges.

frère jacques de beaulieu in bruges A new surgical technique began to spread throughout Europe in the late seventeenth century: lateral lithotomy or la taille latérale, in which the incision in the perineum is no lon-

ger made in the midline but to one side (mostly the left). The best known itinerant lithotomist working in the Low Countries around 1700 was the French monk, Frère Jacques Beaulieu (1651–1714) (Fig. 23). He developed the lateral lithotomy technique that made his name throughout Europe. He also worked in Bruges, as we see from the municipal accounts for 1699: ‘To Cornelius Kelderman and Pieter Lambiot, master surgeons of this city, for their services. Assistance and expenses undergone at the time that Brother Jacques Beaulieu, hermit of Burgundy, practitioner of bladder stone and hernia surgery and experienced in the aforesaid operations, which he has performed here for both the wealthy and the poor out of pure charity, without wishing remuneration or recompense, by order nine pounds and 14 guilders.’ A passage in the accounts for 1705 alludes to the same monk. In this instance, the sum of 12 pounds was paid to the Bruges Capuchins for bringing to the city a hermit from Burgundy who was highly skilled in ‘cutting for the stone and hernias’ and who did not wish to accept any reward from the citizens.

the medionaet: a less familiar surgeon’s duty during corporal punishment in bruges Johan J. Mattelaer

Medieval justice regarded torture as a legitimate investigative method and corporal punishment as a disciplinary tool. From the early fifteenth century, the presence of a surgeon – described in this instance as a medionaet or médionat in French – was often required when torture was performed in the Low Countries. His task was to observe the torturer at work and to point out the best places for the amputation of a finger or a hand, and to monitor the victim and to intervene if the subject’s life was in danger.

Cities like Bruges had a full-time executioner, known as the hangman, scharproc, executeur or scherprechter. Smaller towns, where demand was lower, turned where necessary to the municipal executioners of cities like Ghent, Ypres, Lille and Tournai. The hangman van Ghend, for instance, was called to Kortrijk in 1416 to cut off a let (hand or finger) from a certain Maertine ‘that justice be done’.

Torture came in many varieties: flogging, branding, cutting off the nose or the ears, chopping off fingers or hands, piercing the tongue, pulling out one or both eyes, and other corporal punishments (Fig. 24). There is virtually no reference to the presence of a surgeon in the case of executions (hanging, drowning, quartering, and

beheading), even for the purpose of pronouncing the victim dead. Their attendance was only required when the victim was to be tortured or to undergo corporal punishment and was not supposed to die.

The earliest surviving texts on the subject refer to the care the surgeon was supposed to administer to victims of partial hanging. In 1297, for instance, the civic authorities paid Jan Quaethaer three pounds to cover the cost of treating the injuries he sustained having been hanged by his thumbs: Item hebdomada ante Ascencionem Domini Hannecken Quaethaer suspenso per pollices in domo sculteti pro lesione sua iij lb. This was also the case in Bruges in 1520, when the torture of Jan Neyts, a brewer’s journeyman, was postponed because of the severe winter. The Verluyt Bouck (sentence book) states: ‘However, given the great cold and frost and having been advised by the physicians and surgeons, who concluded that it would be dangerous to proceed with the punishment, the said punishment has been deferred until such time as the weather changes.’

Surgeons could also be tasked with showing the torturer the line of the joint when amputating

24 Corporal punishment in the sixteenth century. (From upper left) burning, hanging, blinding, cutting, breaking on the wheel, flogging, beheading and amputation of a hand. Woodcut from Tegler’s Der Laienspiegel (Mainz, 1508) 24

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red to one Jeanette De Vos, who was accused of witchcraft. We cannot help but wonder whether one or two of the figures wearing red cloaks we find in the background of Gerard David’s painting The Judgement of Cambyses are not in fact surgeons or physicians attending the execution (Fig. 25). Van Doorslaer defines the term medionaet as: ‘A task given to physicians, which is very curious and is worthwhile pointing out.

When a criminal was condemned to torture, a doctor was required to attend its administration.

In order, no doubt, to direct the application of the pain and to have the procedure stopped as appropriate. This attendance was paid for specially and is a constant feature in the municipal accounts.’ We also find the word medionaet in Het reglement provisionneel voor de stadsgezworene doctoors (‘Provisional Regulations for Sworn Municipal Physicians’, Mechelen, 1788).

25 a hand or finger. The accounts of the Franc of Bruges for 1537 state: ‘To Master Clays van den Leene, sworn surgeon of the city of Bruges, for having, on the instruction of the council, gone to the scaffold at the court house to show the executioner how he should cut off a finger from the hand of Andries Willems, and also for administering sundry treatments to sundry prisoners who lay injured in Het Steen, by order, six pounds.’

Elsewhere, the same accounts mention: ‘Master Claeys van den Leene and Gregorius Roelpot, sworn surgeons of the city of Bruges, for having, at the request of the aldermen, gone on 27 November 1540 to the scaffold of the executioner to show him how to cut off the right hand

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of one Joos Qaille, in execution of the sentence imposed on him by the court.’

And also: ‘Master Claeys van den Leene and Gregorius Roelpot, sworn surgeons of Bruges, onderkennen by hemlieden on the instruction of the aldermen of this city an de scanbalke which was greviously wounded and daer naar gheinsticieert wiert metten zweerde, by order, eight pounds).’

A payment made to physicians is recorded in the Bruges municipal accounts of 1638, in which doctors named Caestecker and Uttenberghe received 12 carafes of wine for their presence during six hours of torture administe-

25 Gerard David, The Judgement of Cambyses, 1498, oil on wood , Groeningemuseum, Bruges.

Could one or two of the figures in the background, wearing red cloaks, be a surgeon or physician attending the execution as medionaet?

pharmacists in bruges in the sixteenth and seventeenth centuries Evelien Vanden Berghe

They shook, they stared as white’s their shirt: Them it was their poison hurt.

-I tell the tale that I heard told.

Mithridates, he died old.

A. E. Housman (1859–1936). A Shropshire Lad. 1896 The pharmacist’s profession grew out of that of the grocer-druggist. Practitioners belonged to the ‘Neeringhe van de Cruydhalle’, had premises in the municipal market hall and were meesseniers or traders. They sold spices, confectionery and dried fruit. Over time, some of them began to produce their own preparations in addition to selling them, marking the first steps into the profession of pharmacist.

That profession gradually became more official:

a series of municipal by-laws were introduced to regulate and standardise the sector. The first ordinance concerning pharmacists dates from the late fifteenth century (1497) and focused on the control of their preparations. It was above all in the sixteenth and seventeenth centuries, however, that a whole series of new regulations were imposed. A later by-law of 1582 specifies that pharmacists had first to complete a threeyear apprenticeship and undergo a test of their knowledge. This approach not only enhanced the quality of pharmacists’ training, it also gave customers a degree of confidence in their abilities.

The key development was in 1697, when the first Bruges pharmacopoeia appeared. The pu-

blication of this official list of medicines, their effects and instructions for use, did not proceed smoothly. Pharmacists objected especially to the stringent regulation not only of the preparations themselves, but also the price they were permitted to charge for them. To make matters worse, rather than a pharmacist it was – horror of horrors – the physician Dr Vanden Zande who drew up the pharmacopoeia. An ordinance dating from 1760 refers to a new, second, pharmacopoeia, but no trace of this has so far been found. The key innovation did not occur until the eighteenth century, when the Collegium Medicum was founded to regulate the medical professions and on which there were two permanent seats for pharmacists.

Meanwhile, there had been a pharmacy in the

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26 Sister Aloïse Hammers in the pharmacy (nineteenth century). Album Zusters van Sint-Jan

27 Medicine jar labelled ‘Theriaca’, seventeenth century

26 former brothers’ quarters at Sint-Janshospitaal since 1645 (Fig. 26), by which time only nuns were employed as nurses. They were assisted in the pharmacy by qualified pharmacists until around 1651. The pharmacists were responsible for purchasing the necessary supplies, but they also trained the nuns so that they could run the pharmacy independently. The sisters subsequently trained each other themselves. They appear to have been left to their own devices as pharmacists’ freedom was being curtailed in the sixteenth and especially the seventeenth century, and while the sector was being professionalized.

of St Catherine, the religieuse ziekenmeesteres from the Penitents Convent in Oudenaarde.

They did not, however, escape oversight entirely. The pharmacy at Sint-Janshospitaal also prepared the remedy theriac or mithridate (Fig. 27), a celebrated ancient panacea, originally intended as an antidote to poison, developed for King Mithridates vi (second century bce).

The Romans discovered it via Nero’s personal

In addition to separate formula sheets, theriac recipes are found in numerous pharmaceutical publications, one of which was set down in the Winckelbouck, begun in 1751, by an apothecaresse. A version of this miracle drug also appears in another, largely unknown work in the hospital pharmacy by the ‘forgotten’ Bruges pharmacist Joannes or Jan Bisschop: Pharmacia Galenica & chymica. De vermeerderde ende verbeterde Apotheker en Alchymiste Licht ende Distilleerkonst (Fig 28).

The author of this intriguing little book long remained unidentified until his initials i.b.s.i. gave him away: Jan Bisschop Societatis Jesu. We know from a variety of sources that Jan Bis-

The nuns refer to themselves in the surviving accounts as zusters-apothecaresses, although no evidence has been found that they ever completed an apprenticeship or passed an examination. This might have been because they only prepared medicines for their own patients and for nearby Bruges hospitals like Sint-Juliaan.

The nuns are known to have exchanged formulas with other convents. The Winckelbouck (‘Shop Book’) – although it only dates from the eighteenth century – records that a nun received a formula from a certain Sister Robertine 27

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physician Andromachus, and it enjoyed considerable popularity until the eighteenth century.

There were several variations and the most elaborate formula included over 60 ingredients, the quality of which was so important that they had to be approved in advance before preparation could even begin. Various formulas have survived, including several from the sixteenth and seventeenth centuries, indicating that the hospital pharmacy produced exceptionally large quantities of theriac.

schop was born in Bruges in 1590 and probably worked there for a time as a pharmacist. It is also assumed that he was trained in the city.

He even refers in surviving documents to having visited ‘het gasthuis’, which most probably refers to Sint-Janshospitaal. Bisschop moved to Ghent in 1613, where he joined the Jesuit order. He ran the apothecarije there and trained numerous apprentice pharmacists who went on to pass the official examination. He later served as official pharmacist at the Vienna court of Emperor Ferdinand ii. His book probably owed its sales to its extremely practical approach: Bisschop himself explicitly states that he wrote it ‘to educate pharmacists’. An appealing piece of evidence that he succeeded in his goal is found on the final page of the copy in Sint-Janshospitaal (1667 edition), which is inscribed ‘Book for the use of Sister Eleanora Verbeke, now a nun at the hospital of St John in Bruges, 1741’.

28 Jan Bisschop, Pharmacia Galenica & Chymica. De vermeerderde ende verbeterde Apotheker en Alchymiste Licht ende Distilleerkonst, 1667, OCMW collection.

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a passport to heaven. veneration of saints in the sixteenth and seventeenth centuries Sibylla Goegebuer

the search for balance The exhibition ‘From Surgeons to Plague Saints: Illness in Bruges in the sixteenth and seventeenth centuries’ explores how society in that period sought to balance the roles given to worship and to medical science respectively in the pursuit of a long and moral life and a death inspired by God. The dividing line between a rationally and an irrationally founded world view was far from fixed: it fluctuated between matter-offact and emotional responses to life’s events and evolved as science and society themselves developed. The shift in religious and medical attitudes at European level that began in the sixteenth century has been adopted as the exhibition’s leitmotif and mapped onto the situation in Bruges. The exhibition offers visitors a visual survey of the interaction between faith and medicine, based on works of art, publications, archival documents, instruments and implements,

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and medical and scientific information. Lasting five months, it spans two hundred years of medicine and devotion.

softening a harsh reality Ludovico Guicciardini (Florence 1521–Antwerp 1589) paid little attention in his Descrittione

di tutti i Paesi Bassi, altrimenti detti Germania inferiore, published in 1567, to signals of the coming social, economic and mental depression. How was this phase in history reflected in patterns of worship at the time? How did social grievances come to be grafted onto growing religious divisions? How did people anticipate impending calamity through prayer? Did religion

29 St Barbara consoling the dying, c. 1700, engraving, Austrian?, inv. V0048926, Wellcome Library, London A priest comforts a dying man. Death – holding an hourglass and scythe – keeps watch nearby. A winged man, symbolizing time, points at the words in a book.

St Barbara appears at the top, alongside her attribute, the tower. She holds a chalice with the host, representing the Eucharist, in her right hand. The light of mercy beams down from her heart onto the dying woman.

and by extension religious art offer any kind of sanctuary? How was the consolation of worship used to soften the edges of a harsh reality? These are the questions explored in the exhibition.

Cities have functioned since the Middle Ages as administrative and economic centres, governed by the bourgeoisie, nobility and the Church.

Saints were part of the everyday lives of virtually the entire population. Worship of God and veneration of the saints and their relics were among the daily concerns and duties of the burgher elite, the nobility, the clergy and the common people, in the towns and countryside alike. Confraternities lay at the basis of urban piety and veneration of saints. Hermits opted for a fairly radical form of isolated living – whether or not within the urban community – modelled on the lives of the saints and for the benefit of human worship. ‘Living saints’, they embodied the ideal of pious devotion. Pilgrimages meanwhile centred on the veneration of the ‘dead’ saint. Monasteries, abbeys and churches were gateways to heaven. Artists found an ideal source amid all this economic and religious activity for commissions of a predominantly devotional character.

Paintings of saints and their lives, together with reliquaries, offered visible and tangible inspiration for a lifestyle governed by devotion. Scenes from the Passion of Christ or the life of Mary or the saints, accompanied in some cases by portraits of the donors, brought those who gazed at them and those who commissioned them a step closer to heaven. People prayed to saints, who were venerated as intercessors with God. They acted as mediators and protected believers from danger and disease. They are depicted in art with the instruments of their martyrdom and/ or symbolic details from their lives. Achieving eternal life purified by proximity to God and the saints in the afterlife was everyone’s goal – a mentality reflected in piously inspired art. Artefacts with a devotional character were products linked inseparably with the lifelong journey toward this spiritual purification. The people who commissioned them hoped in this way to secure themselves an eternal place in heaven. Works

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of this kind continue to shape the way religious devotion is viewed to this day.

emotional framework Views on life and death coalesced during the Middle Ages into a coherent set of ideas that

was consistently infused with a near-uniform pattern of thinking, which in turn generated a sense of belonging. Human imagination, faith and desire for salvation and support are interconnected and an emotional sense took root and proliferated in the early and high Middle

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Ages that every mortal was allotted a similar fate on earth and in heaven and hell. That feeling – part of the intangible history of devotion – remained strong in the later Middle Ages and through to the seventeenth century, fortified by concrete, worldly facts as and when these arose. This emotional framework helped set the pattern of life, which became an uninterrupted preparation for the inevitable step into the afterlife. Society was convinced that this preparation was something best not embarked on alone.

The hierarchy of dominant and subordinate social classes immersed the population in literary and artistic, visual messages, in religious and social exhortations and guidelines that laid out the path to be followed. Everything was instilled with the trinity of worship, the lives of the saints as edifying example and the institution of the Church, forcibly clearing the path to heaven. The course of human life was outlined in as close analogy as possible to the life of Christ and those of the saints. The complex of actions and effects at spiritual, social and psychological level functioned practically and pragmatically.

A devotional attitude and allocating saints specific niches based on the particular tasks and powers they were expected to deliver, met a social need.

duality between preservation and renewal The sixteenth century touched a nerve as far as European religion was concerned. A duality arose in the religious world between preservation and innovation, which was also reflected in religious art. A similar dichotomy is apparent in the development of medical science. A lot of medieval attitudes were still embedded in religious thinking. People remained true to the original symbols, but new themes emerged too, drawn from the living tradition. Plague epidemics in the sixteenth and seventeenth centuries drove an increase in veneration of the Eucharist. Devotion to the Cross, the symbol of unity in Christian society, increased from the seventeenth century onward under the influence of the Counter-Reformation, with particular reference to Christ’s

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twofold nature as God and human being. The Cross was the symbol binding earth with heaven and its worship paved the way toward a divine afterlife. Art legitimated veneration of this kind, just as processions and other customs did.

It is not always possible to achieve a strict distinction between devotional practice in specific towns or regions in the sixteenth and seventeenth centuries: we frequently lack sufficiently concrete and specific source material to form a precise and complete picture of worship. Common devotional features are often found in several different places. On top of that, we have the problem of a lack of uniform information for particular cult locations, attributable to the fact that the site in question is not always a public place of worship, or has ceased to be. The organizational structure of the institution – not always known – played a decisive role in disseminating the pattern of religious thinking, which extended beyond the relevant place of worship alone. Intangible history, of which worship forms part, largely spreads mouth to mouth.

Devotion made ample use of visual aids. Spirituality remained inseparable from the real, living world. Piety and factual reality cross-fertilized one another as and when the need arose, and it is that fact that makes it possible to identify a thread running through the world of sixteenth and seventeenth-century devotional thinking.

Religious practices sent out signals to reality, setting out beacons and markers at the moment devotion manifested itself. Knowledge of the veneration of the saints linked to a location helps sketch a portrait of the time.

patron. Veneration of St Barbara was powerfully stimulated during both the Reformation and Counter-Reformation. Few saints, incidentally, popped up out of nowhere in the sixteenth and seventeenth centuries, nor, after the seventeenth, did they disappear abruptly from devotional life either. The illustration of ‘A dying man, beset by demons’ from the Apocalypsis S. Johannis cum glossis et Vita S. Johannis (c. 1420–30), shows several saints who were still venerated in the sixteenth and seventeenth centuries in the context of death, and who had become part of the collective consciousness.

St Barbara had her own place within these visual Ars moriendi.

She was venerated in the hope of averting accidental death without benefit of the last rites.

Special mention was made of the cult of St Barbara in the seventeenth century in the records

st barbara The veneration of St Barbara is an example of such a beacon. She was the exemplar of courage through faith in an anti-Christian climate.

From the late fourteenth century onwards, she became one of the best-loved saints, even though she had been known in the west since the ninth century. The ‘Devotio Moderna’ or Modern Devotion movement placed her on a pedestal and professional groups adopted her as their

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of Sint-Janshospitaal. The outbreaks of plague in that period in Bruges led to her taking on the new function of ‘plague saint’. Virgin saints were particularly venerated in the sixteenth and seventeenth centuries, so the martyrdom of the virgin Barbara, favoured by God’s grace from birth, and her independent attitude toward men helped raise her fame and her veneration to almost dizzying heights. Her picture slotted perfectly into the religious album of the time and her veneration at Sint-Janshospitaal in Bruges is wholly understandable. The hospital function has to be placed firmly in the context of being ill and dying. As an exceptional female virgin saint, Barbara will undoubtedly have had special appeal to the nuns who staffed the hospital, while the threat of plague to the city raised the human need for consolation and assistance. St Barbara offered spiritual solace.

In addition to the importance of the identity of the saint venerated at a particular location and time, the place where his or her image was specifically installed also has a significance that ought not to be underestimated. The tangible presence of a saint makes it a ‘holy’ place and legitimizes devotion. Physical heri-

tage defines the holy character of the cult location. Even in the twenty-first century, St Barbara remains an icon against sudden death among certain professional groups. Her eternal beauty and the variety with which she is represented also help explain her exceptional popularity across the boundaries of time and locations of worship.

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30 Anonymous, St Barbara, sculpture, oak, late-fifteenth or early sixteenth century. Memling in Sint-Jan – Hospitaalmuseum, Bruges 31 A dying man is tempted by demons, Apocalypsis S. Johanniscum glossis et Vita S. Johannis, c. 1420–30, ink and watercolour, inv. L0029294, Wellcome Library, London 32 Martyrdom of St Barbara, engraving

by Wierix after Johannes Stradanus, inv. V0031660, Wellcome Library, London 32

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a look at death in sixteenth- and seventeenth-century bruges culture soetkin Vanhauwaert

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On 24 March 1487, a man called Boudin, residing near Vrijdagmarkt, was killed in a fight with a certain Lauwereins, while on 8 July 1488 Cornelis, the bell ringer at Sint-Salvatorkerk, fell from the church tower and died instantly. These are just two of many similar anecdotes contained in the manuscript Tghuene dat geschied es binner stede van Brugghe (‘What Happened in the City of Bruges’), showing that death was part of everyday medieval life. While plague and other epidemics raised mortality rates during certain periods, the high level of child mortality also meant that overall life expectancy was lower than it is today. Frequent wars and outbreaks of disease meant that medieval people were confronted by death in their communities.

However, the tradition in which patients were cared for and died at home also made death a part of everyday life.

personal examination at the Last Judgement.

According to the Church, however, its destiny was still very much in the individual’s own hands, making it important to prepare carefully for the transition to another world.

But death was not seen as the end: believers hoped for a new beginning in heaven, with the less fortunate going to hell. The notion of purgatory arose around 1200, where the soul would go temporarily after death to be purified of sin before being admitted to heaven. The soul’s ultimate destination would be decided during a

memento mori

Although death rates declined, this belief remained prominent in the sixteenth and seventeenth centuries. People were still concerned about the fate of their souls after death, for which they prepared by simultaneously pursuing a good life – charity, prayer, confession, pilgrimages and donations – and a ‘good death’ – in the presence of a priest or relatives, and consoled by the last rites. It was important never to lose sight of that goal, and so a tendency arose in material culture to remind people of their mortality. This article discusses a number of Bruges art works in that context.

The idea of the transience of earthly existence was a powerful theme in painting from the fifteenth century onwards, but especially during the sixteenth and seventeenth centuries.

The Donor Portrait of Margareta van Metteneye (c. 1525–30) shows the Bruges woman knee-

ling on a prayer stool, accompanied by a boy and by St Margaret in an imposing architectural setting. The rear of the panel, meanwhile, features a skull with worms, together with the stark message: Dat ghy zyt hebbe ic ghewest en dat ic ben dat zult ghy worden (‘What you are, I was, and what I am, you will be’) (Fig. 33). The fact that death is inevitable for everyone is here made explicit. The exhortation to pray for their own salvation and that of Margareta van Metteneye, thereby reducing the burden of everyone’s sin, is made plain in the words Bid God door my (‘pray God through me’) on the painting’s frame.

Similar ‘memento mori’ iconography can be found on tombstones from the same period. A skull and an hourglass can still be made out in a fragment from the tomb of P. Tristram (OnzeLieve-Vrouwekerk, Bruges), the former referring to man’s mortality and the latter to the fleeting nature of earthly life. The message is ‘Reflect on the fate of your soul and turn to God! Live well now, while it’s still possible.’ Skulls also feature in the iconography of several tombstones of nurses at Sint-Janshospitaal (Bruges, Hospital Museum).

the ideal death As previously stated, not only was an exemplary life an asset after death, the way a person died could also determine the fate of his or her soul.

It was important to prepare for death by prayer, a final confession and receiving the last rites.

Sudden death precluded all that and was thus widely dreaded. Medieval people believed that the sight of St Christopher would protect you on that day from unexpected death, while St Barbara would make sure you remained alive long enough for the priest to come.

A manual on how to die well was published in the fifteenth century. The Ars moriendi, as it was called, offered prayers and calls for reflection, together with guidelines on how to overcome temptations like vanity and despair in the hour of one’s death. In many cases, the texts were accompanied by encouraging pictures of temptations being defeated. The Bruges Municipal Archives have a fragment of a late-fifteenthcentury block book depicting the Triumph of Faith (Fig. 34). An angel, the Holy Trinity, Mary and several saints surround the bed of the dying man, while three vanquished demons flee.

The Death of the Virgin represented the ideal end in this period, thanks to four elements in the story, which is recounted in detail in the Legenda Aurea: firstly, Mary knew through divine inspiration that she was going to die; and secondly she was comforted by the presence of the Apostles. The third element comprised the prayers and psalms they read to her, while fourthly, they decorated her room with salutary symbols, such as incense and candles, to keep the influence of Evil at bay. Mary was thus able to die full of confidence, upon which Christ carried her up to Heaven. The image of the dying Mary, surrounded by grieving apostles, inspired many artists, who disseminated this notion of the ideal death.

saints and memories Mary was not the only influential figure in the context of death – other saints too had a crucial

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part to play in the personal judgement of the deceased. Believers therefore sought to forge a link during their lives with a saint with whom they felt a particular affinity. Patron saints were especially popular in this regard. On his memorial stone (Onze-Lieve-Vrouwekerk, Bruges, c. 1526), the priest Simon Volpot is supported

by St Simon (whom we recognize from the saw in his right hand) as he kneels before Christ and the Virgin (Fig. 35). This way, he hoped to receive not only Simon’s assistance, but also that of the Madonna as a reward for his eternal devotion. The memorial of Jan de Schietere and his wife (Sint-Salvatorkathedraal, Bruges,

c. 1576–77) likewise shows the couple in the company of their respective patron saints. They kneel at the foot of the cross, accompanied by John the Baptist and St Catherine, to show their devotion to the Passion of Christ in the hope of easing their own life after death. The donation of commemorative scenes like this to religious institutions was itself seen as conducive to salvation, and was a common practice in the period in question.

Through such memorials, the dead continued indirectly to attract the attention of the living.

This kept their memory alive and encouraged the faithful to pray for their souls, lightening

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centuries, death remained a common factor.

Everybody would die one day, and the already deceased did not hesitate to remind the living of that fact from their tombs and memorials. Death could strike at any moment, so it was advisable to be ready to confront one’s sins. ‘What you are, I was, and what I am, you will be.’

1. Circle of Lanceloot Blondeel, Donor Portrait of Margareta van Metteneye and Memento Mori, 1523, panel. Groeninge Museum, Bruges.

2. Anonymous, Triumph of Faith, late-fifteenth century, fragment of a printed book. Bruges, Stadsarchief, Oud Archief reeks 540.

3. Anonymous, Tombstone of Simon Volpot with memorial scene, 1526, limestone. Onze-LieveVrouwekerk, Bruges.

35 their own burden of sin and at the same time reducing the number of days the deceased would have to spend in Purgatory. Deathbed portraits, which appeared in the sixteenth century, were another way of preserving the memory of the deceased, who was frequently portrayed surrounded by symbols of his or her faith. Like several other nurses at Sint-Janshospitaal in Bruges, Barbara Godtschalk was painted on her

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deathbed, dressed in her nun’s habit and with her hands folded in prayer. There is a crucifix next to her and a burning candle – symbol of the Light of Christ. Paintings like this are precursors of the prayer cards that are still distributed at Catholic funerals.

Although society grew considerably more individualistic in the sixteenth and seventeenth

LENDERS Exhibition ‘From Surgeons to Plague Saints. Illness in Bruges in the Sixteenth and Seventeenth Centuries’, Memling in Sin-Jan – Hospitaalmuseum 29 September 2011 – 26 February 2012 BELGIUM

THE NETHERLANDS

Mrs Rapaert de Grass

Privécollectie R. Butzelaar, Amsterdam

Private collection Prof. Dr. Luc Baert

Dr. Alphons Ypma, uroloog, Diepenveen

Plantin-Moretus Museum/Print Room, Antwerp - UNESCO World Heritage

Rijksmuseum voor de Geschiedenis van de Natuurwetenschappen en van

Site

de Geneeskunde ‘Museum Boerhaave’, Leiden

Musea en Erfgoed Antwerpen Vzw

Museum Boijmans Van Beuningen, Rotterdam

Private collection, Antwerpen Bruggemuseum – archeologie, Bruges

U.K.

Brugesmuseum – gruuthuse, Bruges

Wellcome Trust, Wellcome Library, London

Groeningemuseum, Bruges Groeningemuseum, Prentenkabinet, Bruges

U.S.A

Stadsarchief, Bruges

The Cartin Collection, Hartford

Rijksarchief, Bruges

William P. Didusch Center for Urologic History, American Urological Asso-

Stedelijke Openbare Bibliotheek ‘Biekorf’, Bruges

ciation, Linthicum

Klooster Hospitaalzusters van Sint-Jan, Huuse Sint-Jan, Bruges OCMW Brugge, Archief- & Kunstpatrimonium Archief Klooster van de EE. PP. Ongeschoeide Karmelieten, Bruges Kerkfabriek Sint-Walburgakerk, Bruges Kathedrale Kerkfabriek Sint-Salvator, Bruges Kerkfabriek Sint-Anna, Bruges Private collections, Bruges Dr. William De Groote, Bruges Bob Vanhaverbeke, Bruges PCB Penitentiair Complex, Bruges Musées royaux d’Art et d’Histoire, Brussels Musées royaux des Beaux-Arts de Belgique, Brussels U.L.B. – Musée de la Médecine, Campus Erasme, Brussels Collectie Museum Sint-Janshospitaal, Damme Stad Diksmuide Universiteit Gent, Museum voor de Geschiedenis van de Wetenschappen Stichting Jan Palfijn, Ghent Universiteit Gent, Universiteitsbibliotheek Museum voor Schone Kunsten, Ghent OBK Openbare Bibliotheek, Kortrijk Privéverzameling, Kortrijk Volkskunde – West-Vlaanderen Vzw Antiek Pol Desmet, Wingene

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LITERATURE 800 jaar Sint-Janshospitaal Brugge, 1188/1976, Bruges, C.O.O., 1976 (exhib. cat., 2 volumes).

Ariès, P., Het beeld van de dood, translation from French, 2ndedition, Amsterdam, 2003.

Baert B., De vrouw van de toren. Omtrent de betekenis van de heilige Barbara in de traditie, in: Bovenaards en ondergronds. Het verhaal van Sint-Barbara 2006-2007, Cahier 2, Stad Genk, December 2006.

Boelaert J.R., Zes eeuwen infectie in Brugge: 1200-1800. Leuven, ACCO, 2011.

Boeynaems P. , ‘Broeder Jan Bisschop en zijn Pharmacia Galenica et Chymica’, Bulletin van de Kring voor de Geschiedenis van de Farmacie Benelux, no. 15, April 1957.

Böhmer S. e.a., Von der Erde zum Himmel, Heiligendarstellungen des Spätmittelalters, Aachen, 1993.

Broeckx M.C., Essai sur la médecine Belge avant le 19ième siècle, Ghent, 1837.

De Meyer I., Origine des apothicaires de Bruges, Drukkerij Felix de Pachtere, 1842, Bruges.

Deneweth H., Huizen en mensen. Wonen, verbouwen, investeren en lenen in drie Brugse wijken van de late middeleeuwen tot de negentiende eeuw (Brussels, 2008, unpublished doctoral thesis).

Dewitte A., De geneeskunde te Brugge in de middeleeuwen, Brugge, Heemkundige kring M. Van Coppenolle, 1973.

D’Hooghe C., De armenzorg te Brugge in de 17de eeuw, onuitgegeven licentiaatsverhandeling, RUGent, 1950.

Geldhof J., De pestepidemie in Brugge, 1665-1667, Biekorf, 75 (1974) 305-328.

L’initiative publique des communes en Belgique. Fondements historiques (Ancien Régime). 11e Colloque international Spa, 1-4 sept. 1982. Actes (Brussel, 1984) (Pro Civitate, Historische Uitgaven, Reeks in 8°, 65).

Maréchal G., Het Sint-Janshospitaal in Brugge in de 18de eeuw. Aanzet tot vernieuwing? In: Handelingen van het Genootschap voor Geschiedenis 132 (1995)1-2, pp.5-60.

Maréchal G., Het gebouw van de Brugse leprozerie in de XVIde eeuw. In: Biekorf 1979, pp.316-322.

Mattelaer J., Le médionat, une tâche moins connue du barbier-chirurgien lors d’une exécution, Janus, Revue internationale de l’histoire des sciences, de la médecine, de la pharmacie et de la technique, p.137-147, 1974.

Mattelaer J. Steensnijden in Vlaanderen in de 17de en de 18de eeuw, Geschiedenis der Geneeskunde, 1, Januari 1955.

OCMW-archief, De bestanden Sint-Janshospitaal, Sint-Juliaan en M.Magdalena.

Pannier R.A.C., Van gissen naar weten. De geneeskunde in Brugge in de 17de eeuw, de tijd van Thomas Montanus, Brugge, Van de Wiele, 2008.

Spicer A. e.a., Defining the Holy. Sacred space in Medieval and Early Modern Europe, Hants, 2005.

Tussen hemel en hel. Sterven in de middeleeuwen, 600-1600 (tent. cat.), Sophie Balace and Alexandra De Poorter (eds.), Brussels, 2010.

Vandevyvere E., Watervoorziening te Brugge van de 13de tot de 20ste eeuw (Bruges, 1983).

Vandewiele L. J., ‘Enkele nieuwe gegevens over apoteker Jan Bisschop, Jezuïet’, Bulletin van de Kring voor de Geschiedenis van de farmacie Benelux, no.

50, maart 1975.

Van Doorslaer G., Aperçu historique sur la médecine et les médecins à Malines avant le 19ième siècle, Mechelen, 1900.

Vlachos S., Unerträgliche Kreatürlichkeit. Leid und Tod Christi in der spätmittelalterlichen Kunst, Museen der Stadt Regensburg, 2010.

(Anonymous), Tghuene dat geschied es binner stede van Brugghe sichten tjaer ons heeren M.CCCC. ende lxxvij, den XIIII’ton dach in spurkelle.

Manuscript 13267-13269, Bibliothèque royale de Belgique, Brussels.

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Credits

SPECIAL SUPPORTERS:

Museum bulletin is a quarterly magazine of Musea Brugge, published by vzw Vrienden van de Stedelijke Musea Brugge Responsible Publisher: Bertil van Outryve d’Ydewalle, p/a Dijver 12, 8000 Brugge Coordination: Johan R. Boelaert & Sibylla Goegebuer Copy Editing: Johan R. Boelaert Editors: Johan R. Boelaert, Sibylla Goegebuer, Mieke Parez museumbulletin.redactie@brugge.be Photography: Municipal Photographers Jan Termont and Matthias Desmet, Steven Kersse, Wellcome Library London, Raakvlak, Stad Diksmuide, Johan R. Boelaert, Albert Clarysse, Johan Mattelaer, Heidi Deneweth, Nico Insleghers, Museum Boerhaave Leiden, A. Leun, Archief & Kunstpatrimonium OCMW Brugge Layout: Agates, Brugge Printer: De Windroos, Beernem Translation: Ted Alkins, Heverlee

Musea Brugge Dijver 12, 8000 Brugge T 050 44 87 43 F 050 44 87 78 www.museabrugge.be musea@brugge.be

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