Doctors
From Barber-Surgeons to University Physicians
By Isabelle Devos
Today, doctors are highly trained professionals at the heart of our healthcare system. Yet this was not always the case.
In 19th-century Belgium, doctors worked within an unequalven medical world, competing with barber-surgeons, quacks, and midwives.
Over the decades that followed, this world was gradually transformed by university education, state regulation, and new scientific knowledge.
As medicine expanded into everyday life, the position of doctors strengthened. Their numbers increased significantly not only over time, but also across (most of) the country.
In the early nineteenth century, medical practice in Belgium was organised in a hierarchical manner.
At the top were university-educated physicians, who enjoyed high social status and focused primarily on theory, diagnosis and the prescription of treatments.
Below them were barber-surgeons who were trained through practical experience and apprenticeships. They carried out hands-on procedures such as wound care, bloodletting, and amputations.
Alongside these officially recognised practitioners operated a wide range of quacks, who lacked formal training and offered herbal remedies, folk cures, and sometimes ‘magical’ treatments (see Figure 1). Although condemned by medical authorities, they remained popular because they were inexpensive and travelled widely across the countryside.
The term “barber-surgeon” comes from medieval Europe, when barbers did more than cut hair, and performed basic surgeries. Surgeon comes from Greek cheirourgos (“working with the hands”), and barber comes from Latin barba (“beard”). Tasks like bloodletting, tooth extraction, and amputations were considered practical labour, so barbers skilled with sharp tools such as razors and blades performed these. Over time, surgeons became respected medical specialists, and barbers returned to grooming only.
The quack in the village
Figure 1: Painting by Théodore Cériez, 1872, SM 002611, Collection Yper Museum
From 1831 onward, government regulation in Belgium gradually narrowed the divide between physicians and surgeons, ultimately merging them into a single medical profession.
From 1835 onwards, universities were entrusted with full responsibility for medical education, which was modernised and made more practice oriented. University training for pharmacists followed in 1849, and dentists in 1884.
These reforms had a strong impact: the proportion of university-trained physicians rose from approximately 48% in 1830 to around 80% by 1880. At the same time, quackery was progressively restricted, even though it never completely disappeared from everyday life.
Medicalisation
Yet this did not mean that medical care became accessible to everyone.
In 1861, according to the Annuaire médical de la Belgique, an administrative medical report, about 70% of the 2,538 Belgian municipalities had no resident physician or surgeon (see Figure 2a).
Physician density (the number of doctors and surgeons relative to the population size of the municipality), was particularly low in coastal Flanders and southern Belgium (the Ardennes), where running a medical practice was financially unattractive.
Doctors were less likely to work in these rural areas because the population was sparse and difficult to reach, and most people could not afford professional medical services.
Nor did the number of doctors increase steadily over time (see Figure 3). In fact, physician density declined slightly, from about five doctors per 10,000 inhabitants in the 1830s and 1840s to around four between 1850 and 1880, largely a result of stricter university training requirements. From the 1890s onward, the situation began to change. Medical education expanded, and specialisation accelerated (see section on hospitals).
Toward better access
Hospitals in Belgium, 1939
Figure 3a. Hospitals in Belgium ca. 1939. (Sources: 1939: Annuaire de la Santé Publique, 1939).
The early twentieth century marked the start of a more structured hospital network across the country.
Brussels and central Belgium developed into major hospital hubs, while cities such as Ghent, Liège, and Antwerp strengthened their regional roles.
By 1939, hospital care had expanded significantly, reducing some regional inequalities. This development reflected growing public involvement in healthcare, marked by the creation of Belgium’s first Ministry of Public Health in 1936.
This increasing government attention to health went hand in hand with the rise of mutual health insurance funds since the late nineteenth century, which played a crucial role in making medical care more widely available.
By this time, the medical profession had also become highly specialised, with growing numbers of trained experts working in hospitals, universities, and public health institutions across the country.
Still, peripheral regions such as the Ardennes and parts of Limburg and Luxembourg province continued to lag behind (Figure 3a).
After the Second World War, medical infrastructure in Belgium improved in many ways. The government expanded the welfare state, introducing compulsory health insurance, which made healthcare more affordable for everyone. People could now visit a doctor or go to a hospital and worry less about the cost.
Hospitals also entered a new era. New technologies like X-rays, antibiotics, and heart monitors, allowed doctors to diagnose and treat illnesses more effectively. Medical care became more organised and team-based, with doctors, nurses, and specialists working together. Patients were no longer just treated, they were monitored, tested, and followed up. The family doctor remained the first point of contact and referred patients to hospitals when complex care was needed.
By 1970, Belgium had achieved near-universal hospital coverage, with 458 hospitals (Figure 3b). Nearly everyone lived within five kilometres of a hospital, apart from some rural areas in the Ardennes, Limburg and West Flanders. Major cities developed dense concentrations of large and specialized institutions.
Hospitals in Belgium, 1939 versus 1970
Figure 3b. Hospitals in Belgium 1970 (Sources: Annuaire de la Santé Publique, 1970).
Increasing specialisation and integration
From the 1980s onward, medicine became even more specialised.
Many disciplines were divided into smaller subspecialties. For example, cardiology split into interventional cardiology, cardiac imaging, and the treatment of heart rhythm disorders. This allowed for more precise and targeted care. At the same time, patients were increasingly treated by teams of specialists rather than by a single doctor.
Hospitals also became more technological. They were equipped with advanced machines such as MRI and CT scanners, instruments for keyhole surgery, and other high-tech equipment.
Medical care became more dependent on technology, scientific research, and teamwork. However, this growing complexity also brought challenges, especially rising costs and fragmented care.
In the past decade, healthcare policy in Belgium has therefore placed greater emphasis on integration. General practitioners and specialists are encouraged to collaborate more closely, using digital tools and shared electronic health records.
Hospital mergers have also taken place, often leading to the closure of smaller hospitals in small cities, to improve efficiency. As a result, patients increasingly receive coordinated care in large-scale institutions, where treatments are based on the latest scientific research.
TODAY, Belgium has seven university hospitals that combine specialized care with academic research and medical education:
- UZ Leuven,
- UZ Gent,
- UZ Antwerpen,
- UZ Brussel,
- Hôpital Erasme,
- CHU de Liège, and
- Cliniques universitaires Saint-Luc.
UZ Leuven has the oldest origins, tracing back to the Sint-Pietershospital founded in 1080, and evolved into a modern multi-campus university hospital during the twentieth century.
UZ Gent grew out of nineteenth-century medical training at the Bijloke city hospital, with construction of a dedicated medical institute beginning in 1937 and its official opening in 1959.
In Brussels, UZ Brussel, Cliniques universitaires Saint-Luc, and Hôpital Erasme were founded in the 1970s as university hospitals closely linked to the VUB, UCLouvain, and ULB.
UZ Antwerpen, opened in 1979, and CHU de Liège, founded in 1989, complete the academic hospital landscape.
Want to Read More?
- Jan De Maeyer, Lieve Dhaene, Gilbert Hertcant en Karel Velle (red.), Er is leven voor de dood. Tweehonderd jaar gezondheidszorg in Vlaanderen, Kapellen: Pelckmans, 1998.
- Robrecht Van Hee, Het Stuivenbergziekenhuis (1879-2022), een erfgoedicoon in Antwerpen,2022.
Sources
L’Atlas Ineqkill des inégalités de mortalité en Belgique fournit des informations détaillées sur la mortalité et les maladies en Belgique de 1820 à 2025.
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