History

This chapter reviews the history of medicine in what were the Belgian colony of Congo and the administered territories of Ruanda-Urundi (now Rwanda and Burundi). Highlighting both the commonalities and particularities of the Belgian case in the history of colonial medicine, the chapter examines the four main aspects of Western medical endeavours in the Belgian colonies – a state-organised medical service, missionary medicine, industrial medicine and research organisations and activities. While Belgian colonial medicine aligned closely with the activities of other colonial powers, it was exceptional in many ways. Political, economic and church interests vested in the Belgian colonies were in some instances freer to shape the colony as they saw fit, outside the interference of a general metropolitan public. The downside of such disinterest, however, included fewer resources from the metropole and a lack of checks on colonial abuses. Ultimately Belgium, starting a bit 'behind the curve' as a colonial power, had to innovate solutions for health problems in a colony that was poor in resources and political will. Belgian colonial medicine, in the end, left strong traces in the current field of international humanitarian aid.

This chapter offers a varied overview of the historical relation between medicine and religion in Belgium, which was until the 1960s a predominantly Catholic country. Moving beyond a too strong political reading of healthcare debates, in which both fields have been described as opposites (competing with one another or aiming for compromise), this chapter pays attention to intellectual encounters and to the role of religious practices and beliefs in medicine. First, the chapter sketches the evolution of Catholic organisations and institutions, most notably the changing role of religious orders, which in Belgium have held a firm grip on the medical field. It describes evolving Catholic views on ‘care’, along with political conflicts over an expanding welfare state and changing views on the growing role of lay medical personnel. Second, the chapter turns to religious practices, rituals and exceptional phenomena such as miracles, and the medical debates these inspired. From a medical perspective, religion could be a source of health (e.g. ‘moral therapy’ to treat mental illness) or disease (e.g. Christomanie). Third, the chapter goes on to discuss how Catholic doctors and caregivers gave their religious views a place in their professional work and identities. Here the chapter turns to medical ethics and professional codes of conduct, and the ways in which these have been inspired by Catholic thinking. The chapter pays particular attention to questions related to reproductive medicine and the end of life.

This chapter focuses on the ways in which, since the nineteenth century, medicine and medical discourse have legitimised, reinforced or altered gender relations in Belgium. It focuses on three themes: the social division of medical labour, the gendered character of medical knowledge and the role of feminists in claiming and redefining the female body. Addressing the theme of the social division of labour allows us to provide readers with general information about the presence and status of women and men within the main medical structures throughout the period. The chapter presents key social and political debates relevant to the history of medicine, such as discussions on the supposedly limited competences of midwives or women’s access to medical education and the medical profession.

The history of gynaecology enables us to look more closely at the impact of these structures on the treatment of women’s bodies and on discursive practices defining women’s health. Gynaecology emerged at the end of the nineteenth century as a new profession founded on the successes of modern surgery and dedicated to the protection of maternity, femininity and sexual modesty. During the first and in particular the second wave of organised feminism in Belgium, activists involved in political debates about women’s rights had to struggle with stereotypical, often medically legitimised views about women’s moral and physical weaknesses and incapacity to assume various social roles. In women’s political fights centred on themes such as contraception and abortion, feminists developed alternative understandings of women’s bodies, also using medically informed representations.

Medicine has become increasingly professionalised and institutionalised in the modern era. Within this narrative of medicalisation, popularisation has been interpreted as a process directed by the traditional protagonists of medical history: physicians and institutions. Although historians have argued that medical knowledge was ultimately democratised throughout the nineteenth and twentieth centuries, they have mostly portrayed the increasingly large numbers of users of medicine as passive consumers of knowledge that was nominally created by professionals. Over the past two decades, however, historians have paid more attention to the circulation of knowledge, arguing that knowledge is constructed by mutual interactions between the scientific and the public domain. In a similar vein, historians have shown that the sharp antagonism between ‘official’ and ‘alternative’ medical beliefs was not a historical reality, but a cultural construct.

This chapter shows the implications of these new theoretical approaches for the Belgian context – in which ‘popular’ and ‘alternative’ views of medicine have not yet been subject to much historical scrutiny. By focusing on visual media through which medical knowledge was communicated and circulated, concrete models displayed in health exhibitions and public health films, this chapter takes a first step to decentralise the history of ‘popularisation’. By drawing attention to the ways in which medicine circulated, we give lay audiences agency in the historical narrative: they transform from passive recipients into active actors and consumers, who have the agency to interpret, choose from and respond to different views of the body, sickness and health.

This chapter outlines how the organisation of financing of the cost of medicine has evolved since the late eighteenth century. The economic burden of caring and healing has been largely ‘mutualised’ over the past two hundred years. It is no longer individual patients who pay the largest part of medical fees, but society, with – as a consequence of the introduction of a compulsory social security system in 1944 – a key role for the state. However, the state delegated this redistribution to non-profit private health insurance funds – mutual societies – which, since the late nineteenth century, developed into central players in financing of healthcare. However, this narrative does not take into account public welfare at local level in financing the cost of care, nor the middle-class philanthropy and Catholic charity that characterised the field in Belgium as well.

The collectivisation of costs makes the discussion on how to fund the system an ongoing topic in the public space, while also tending to conceal the continued existence of major social differences. At the same time, the medical industry (private hospitals, pharmaceutical companies, etc.) became an important economic factor, both as an employer and as a central player in a knowledge-based economy. These changes had effects on the administration of care, requiring new forms of financial efficiency. As medicine became a business, different norms of management were introduced, which, in turn, were heavily criticised.

"The medicalisation of society was strongly intertwined with both the overall scientification of society and the rationalisation of dealing with the social question on a pan-European scale. This chapter reassesses the history of Belgian public health by looking at the social activism of physicians and ‘hygienists’ as part of a global field of discourse and practice. In doing so, it nuances the image of the nineteenth-century state as a ‘nightwatchman’, and in particular for the twentieth century, considers the Belgian Congo as an integral component of Belgian health policies.

The chapter consists of four parts that are structured chronologically. The first part starts in the late eighteenth century and focuses on the emergence of scientific medicine and the growing awareness that the study of many diseases could not be separated from the socio-economic context in which they originated. The second part discusses the bacteriological revolution in the 1870s and its impact on public health questions, linking social medicine more closely to applied sciences and preventive healthcare. Social medicine became increasingly entangled with other reformist movements. The third part deals with the further development of social hygiene and the rise of eugenics, national health protection and improvement policies in the interwar period. Finally, the fourth part re-evaluates the period after 1960 when national public health systems were strongly questioned, local community health centres emerged and medical activism went increasingly beyond borders. For each time period, representative players are highlighted, including Adolphe Burggraeve, Victor Desguin, Gustave Dryepondt, Peter Piot and Marleen Temmerman.

Although medical knowledge has been produced in different forms and locations over the past two centuries, the modern university was certainly its primary locus. The medical faculties of leading educational institutions evolved into the central spaces of scientific research ‒ an evolution that in turn had an impact on the medical curriculum. In Belgium, this ‘scientification’ occurred along the ideological dividing lines between Catholics and liberals, between the Flemish- and French-speaking communities, and was influenced by the competition between state and private universities. Its principal driving force was the development of laboratory science. However, this dominant form of scientific medical knowledge was often contested. Engaging in the age-old debate between medicine as a science and an art, nineteenth-century practitioners claimed to have practical knowledge, rooted in everyday observations, that was just as ‘scientific’. Their knowledge originated primarily around the bedside, what contributed to the changing position of the hospital as an additional professional training site.

This chapter presents the development of medical education at the medical schools and later the faculties of medicine in the southern Netherlands/Belgium from the end of the eighteenth century up until today. It focuses on the shifts in the balance between general education, vocational training and scientific schooling, and on the continuous tension between medical specialisation and (the perceived need of offering) a more holistic approach. The process of professionalisation in general followed a similar line of development in Belgium as in most other European countries, yet many specific circumstances also created a unique situation.

This chapter discusses a rare exception to the archival silence surrounding the experiences of VD sufferers in the interwar period: the personal correspondence of Dr T.P.C. Kirkpatrick, one of twentieth-century Ireland’s foremost VD specialists. Written by current and former patients, their loved ones and other health professionals between 1924 and 1947, the 120 letters which comprise the Kirkpatrick collection offer an unparalleled insight into the medical, social and emotional experiences of VD sufferers and those who supported them during a formative period in British and Irish state welfare provision. By close-reading these letters through a regional and four-nations history perspective, this chapter contradicts a range of common assumptions about the knowledge, agency and self-understanding of VD sufferers. It charts how, amid the mixed welfare economies of interwar Ireland and Britain, current and former patients sought to leverage the recently established state-funded VD Service to achieve their desired social and healthcare outcomes. It reveals how, in their engagement with medical professionals, sufferers and their loved ones strategically performed their gender, age and class identities to solicit aid and advice. It also explores the transformative effect that treatment for VD had on individuals’ capacity to understand and describe their body in a period in which a cultivated ignorance of sexual matters was the norm. In doing so, it offers a rare and unusually direct view into the intimate lives of Irish people and their attitudes towards sex, sexual health and medical authority during a period of significant social and political upheaval.

What are the ethics that shape or should shape engagement with historical medical data, particularly archives containing patient voices? This question has come to the fore through the ‘Men, Women and Care’ project, a European Research Council-funded project creating a database of information drawn from the PIN 26 personal pension award records from the First World War. Held by the National Archives, London, these records contain a wealth of personal information, including potentially sensitive details of medical conditions and diagnoses, as well as material concerning stigmatising social situations, such as domestic violence, prostitution and illegitimacy. Using material drawn from ‘Men, Women and Care’, this chapter considers the opportunities presented and challenges posed by this material as sources for historical analysis. It considers issues of both disciplinary practice and theoretical framing to explore the position of the historian in relation to analysing and disseminating the historical patient voice. In doing so, it asks what use historians can and should make of this information and what steps the historical community might consider taking to articulate a code of ethics around practice that is sensitive both to family feeling and academic enquiry.

This chapter makes the case for using less traditional sources to access the emotional and psychological experiences of patients who lived with stigmatising venereal diseases. Fears about VD became conflated with and exacerbated by a variety of national and imperial crises. At the same time, however, public discussion of VD (and its perceived association with moral malaise and racial health) was aggressively suppressed. Such tensions were further complicated during the interwar years with growing institutional efforts to bring VD within the remit of preventative medicine. Tension between fear and suppression on the one hand, and fascination and scrutiny on the other, fundamentally shaped patient experiences. But it has also meant that patient-authored records of sexual ill-health are scant. In the absence of more traditional historical archives, works of fiction become especially valuable, laying bare the emotional and psychological costs of living (and dying) with VD. This chapter also considers how historical reflections on such stigmatising illness experiences can help to overcome contemporary inequalities in access to sexual-health services.