NOTES ON THE MEDICAL HISTORY OF BRUGES AND THE HOSPITAL OF SAINT JOHN* By HAROLD M. TOVELL, M.D. TORONTO, CANADA N the dim past when the fabric Bardi increased their capital with of Roman administration was de- the prosperity of the town. stroyed and its culture adulter- Politically it rose from being the ated, when Clovis had succeeded seat of an obscure nobleman to the Ito his Merovingian chieftainship andresidence of the counts of Flanders Gregory of Tours in turn had con- and the Dukes of Burgundy. Admired quered the Franks for the Christian alike by plebians, kings and queens, faith, there gradually arose, from this its fame for beauty, pageants and era of shadowy ghosts and mythical wealth spread throughout Europe. chronicles a new civilization nourished Like all medieval towns its joys and sponsored by the Church. A were not continuous. Wars, assaults, few centuries rolled by; Europe com- plagues, rebellion and tortures moved menced to unfold. From the obscurity across the stage with frequent regu- of the great lowland flats of Flanders, larity until the close of the fifteenth on the banks of the Reye, near its century when Bruges, superseded by junction with the Zwin, there in the Antwerp, ceased to be a factor in year 856 a burg and chapel were built commerce. by one Baldwin Bras-de-Fer for the Believing that the high state of purpose of trade. This was the nais- civilization developed in the four- sance of Bruges. teenth and fifteenth centuries would, Around this chateau there gradually from its economic force, advance the collected a community of merchants. status of public health and medicine The Reye became converted into a until they occupied a position in series of canals; streets took form; keeping with the general advance- walls arose; the Zwin became a river ment, I thought it would be of interest of importance. The harbor was the to glance into the history of Bruges safest in the north of Europe. Canals as a representative product of the age. connected it with Ghent, Ypres, Dun- To follow the medical growth of a kirk, Sluys and Furnis. In 1200 it medieval town is a rather difficult was the central mart of the Hanseatic procedure even with archives at league and by the fourteenth century one’s disposal, due to the fact that the it was the Venice of the north. Mer- inhabitants did not record such devel- chants from all countries traded on its opments as diligently as they would quays; the products of the east were a miraculous intervention of a patron bartered for those of the west; the saint or a successful assault upon a furs of Russia for the jewels of the neighboring town. Orient; the wool of England became The twelfth century opened with the cloth of Flanders. The great Bruges occupying practically the same bankers of the world carried on the space as today yet with fewer build- exchange. The Medici, Fuggers and ings. The houses were inflammable, *Read before The Medical Historical Club, Toronto, November 18, 1927. fire was a constant source of destruc- by word of mouth, by writing, pictures tion and terror. The streets were or demonstration.” unpaved and as Flanders enjoyed rain The water supply having been then as now, they were at times solved, the city fathers in their wisdom impassable. Near the market place applied themselves with equal intelli- there was an open cloaca into which gence to drainage. The streets were dead and sometimes live bodies were paved, gutters being provided which thrown. George, one of the murderers drained into receptacles. Special offi- of Charles the Good, after having his cers known as Muederhcren, “officers hands cut off, was cast into the cloaca of mud,” were appointed, whose duties to perish. The canals were filthy, no were to see that the pavements were particular attempt being made to kept clean and repaired, the gutters regulate the water supply; indeed it in good order and the receptacles not was such an unhealthy place that it choked or malodorous. Manure was is difficult to believe that it was of to be disposed of to the neighboring any importance commercially, yet farmers. Partly for hygienic reasons merchants from various countries were but mostly for commercial, the canals established and prospering. With its were deepened and enlarged; a special increasing importance the magistrates boat and crew were appointed to under divers and trying conditions patrol the canals and see that they finally during the thirteenth and four- were free of all offensive materials, teenth centuries evolved an elaborate they being enjoined to pay particular system of drainage and water supply. attention to the removal of dead dogs For the latter, water was led from and pigs. The latter being under St. many clear streams and springs into Anthony’s special care were allowed a large reservoir at St. Bavon, a to roam about at will. nearby hamlet at which point a water- The political situation under Louis house was constructed with two large of Nevers (1322-1346) nearly wrecked towers, all of which have disappeared. the previous good work. Under his The method of distribution was simple regime, the ramparts were destroyed, but effective; buckets running on a the water supply interfered with, chain over a large wheel picked up the canals became clogged; not un- the water from the reservoir and til the general health of the com- emptied it into a large cistern above, munity was threatened did he allow from which point it was distributed in them to be restored to their normal conduits to all parts of the city. Man’s function. Such were a few of the faithful ally, the horse, furnished difficulties experienced by a com- the motive power. That the citizens munity in search of health. Yet were justly proud of this municipal through it all it is surprising to see development is shown by the honour with what persistence the life of the with which they regarded the post of town went on. keeper of the waterhouse. “He swore As a result of Louis’ severe chastise- to be faithful and diligent in his work, ment, Bruges again had to devote that he would guard the Waterhouse much time and money to her pressing and all its instruments, aqueducts needs as she had done in the last half and canals, and that he would never of the previous century. In 1360 pestil- divulge its secret to any living man ence broke out, followed by fire which wiped out a whole section of the especially the roof. The early wooden town. While at the time it seemed a house and thatched roof had always calamity, nevertheless, it served as an been a source of fire. Gradually there incentive to rebuild with better ma- sprang up in various localities brick terial. The main thoroughfares were and stone edifices. Under encourage- repaved, the less important were ment this went on until by fire and stripped down their centers, new law all wooden and thatched houses drains were constructed, the old ones were replaced and where private funds repaired, nor did the work cease till were not sufficient the civic treasury Bruges was remade, and the already helped. While the improvement in the famous waterhouse was enlarged, pro- housing condition may not have arisen vision being made for the erection of from a standpoint of health yet it fountains. Public baths were estab- exerted a beneficial influence. The lished which at first proved of great driving force was economic. benefit to the community but later be- Thus from practically an enclosed came a source of flagrant immorality. field of mud with no water supply, Apparently then as now the sur- drainage or proper housing, we find geons were specially looked after and by the beginning of the fifteenth did not lack for practice, because the century, a veritable city of enchant- magistrates saw fit to construct a ment with its many turretted houses, special pit for the exclusive use of the canals wide and well kept, stone barber surgeons in which they could bridges with graceful arches, foun- deposit the blood drawn from their tains and open spaces; churches and victims. It also suggests that their monasteries. It is no wonder that technique was not above reproach Pius 11 who visited the city in 1435 *s (1361). said to have stated that Bruges was Evidently the old unstable build- one of the three most beautiful cities ings and houses were of such a he had seen, and he was widely nature that the collapse of a wall or travelled. John Paston, one of the the toppling over of a roof or sign, to English gentlemen who attended the the detriment or death of passersby, wedding of Margaret of York with was not uncommon, because we find Charles the Bold, in 1469 wrote: “By according to an old Chronicler (Dam- my troth, I heard never of so great houder) that certain officials named plenty as there is, and as for the Deelmannen were appointed, whose Duke’s court, as for lords, ladies and duty it was to inspect the streets, gentlewomen, knights, squires and dwellings and shops, full power being gentlemen, I heard never of none like given them either to demolish or to to it save King Arthur’s court.’’ We make necessary repairs, all charges are told that, when Margaret entered for such work to be borne by the the town, the streets were covered owner. with cloth-of-gold, silks and tapestries, Dating from the early days and and that the procession had to stop ten extending through the twelfth, thir- times before reaching the market- teenth and fourteenth centuries, we place, to admire tableaux illustrating find a very consistent attempt being episodes of sacred and profane history.