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Care providers in the sixteenth–seventeenth century
Michel Der uytter e
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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 apprentices 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
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 independent 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.
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
