Van Eyck's The Virgin with the Canon: Visual Disability and Societal Attitudes as Depicted in the Northern Renaissance

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Examples of disease as shown in artworks will be examined, from the medical and surgical point of view as well as the historical and artistic ones, particularly visual loss as portrayed by artists from pre-historic times. The special mystery in the story contained within Van Eyck’s The Virgin with The Canon (1436) will then be discussed, providing a fascinating religious, legal, medical and sociological explanation for the Canon’s blindness and contemporary attitudes towards it.

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25 October 2016

Van Eyck’s The Virgin with the Canon:
 Visual Disability and Societal Attitudes as Depicted in the Northern Renaissance

Louis Clearkin FRCS

An interdisciplinary presentation which will draw from art history, medicine, canon law, and changing societal attitudes, in considering artistic representations of medical conditions. The depiction of visual disability in art will set the scene, with examples from pre-history through to the present day. This is followed by an examination of the messages contained in Van Eyck’s medieval masterpiece “The Virgin with The Canon” (1436), which hangs in the Groeningesmuseum, Bruges, Belgium, and a consideration of the medical evidence for the condition depicted, in the context of beliefs of the time.


 On the frame of the painting is this inscription;

“Master George van der Paele, cannon of this church, has had this work made by the painter Jan van Eyck and he founded two chaplaincies to be served by choir personnel, 1434. He completed it in 1436.” 

I’ve often wondered why he would commission a painting when he was completely blind. It is obvious to me as an ophthalmologist he could never have seen this painting.

The painting is the only reason we know of George (or Joris) Van der Paele.

Familiarity with several disciplines is needed to understand how visual compromise fits into the medieval culture; this in turn is central to understanding the purpose and meaning of The Virgin with the Canon.

I plan to point out what then would have been obvious to contemporaries viewing the painting these messages have become unfamiliar and are hidden from many of us today.

I will set out how I think Van der Paele caused Van Eyck to use allegories in the painting to tell his story.

Temporal Arteritis

 There are relatively few diseases that can cause complete blindness of the type Van der Paele suffered. Prominent is disease of the optic nerves, particularly loss of the blood supply due to temporal arteritis.

The picture on the left is an optic nerve swollen because the blood supply has been lost, and the angiogram on the right shows dark areas, where the blood vessels are empty of blood.

Patients with temporal arteritis are initially well, and then become ill with variable severity. Post-mortem studies suggest many patients are no more than generally unwell for a year or two and never exhibit severe features or come to any diagnosis.  Others can be extremely ill, lose their vision or suffer a life threatening illness.  Today, recognition of early symptoms such as malaise, fever, weight loss, headache and jaw pain on chewing, can lead to effective treatment with steroids and prevent visual loss. Untreated temporal arteritis can cause complete blindness.

The diagnosis of temporal arteritis is confirmed by biopsy of the temporal artery, the histology shows the wall of the artery inflamed and swollen to an extent that it is narrowed, cutting off the blood supply. We can see a giant cell granuloma – which gives another name to the condition: giant-cell arteritis.

In France it is known as “le maladie de Horton” after Bayard Horton, a physician at The Mayo Clinic. He achieved dream of many doctors: the recognition of a novel disease (and not just once for Temporal Arteritis,[i] but again for another condition: cluster headache). 

Some patients die of temporal arteritis due to vascular disease elsewhere in the body, which may cause heart attacks, stroke or bowel infarction. If patients survive the early stages, life expectancy is not reduced.

Temporal arteritis is link to a related condition, Polymyalgia Rheumatica, or PMR.

Polymyalgia Rheumatica

A medical giant William Bruce[ii] (centre picture) is credited with being the first to recognize PMR in 1888.  He is also credited with major contributions in Brucellosis and Sleeping Sickness. 

  PMR is a similar inflammatory disorder causing muscle pain and stiffness, especially in the neck shoulders and hip. Untreated, PMR leads to mobility issues; that interfere with or completely interrupt daily living activities.  Movement is so painful that the patient simply stops moving. 

As with Temporal arteritis the patient becomes unwell, with fever, weakness, anorexia and loss of weight. In addition they can’t walk, write, feed themselves, dress, wash or carry out any of the normal tasks of daily living.  Treatment with steroids can be life transforming.

Two questions are prompted by the recognition of an overlooked disease.  Firstly, how did they do it?  Horton and Bruce complied with the essential duties of the physician:

They took a history and examined the patient;They compiled a differential diagnosis, that is, they ranked in order of probability the possible causes of the condition;Used tests to choose between candidate diseases.

Having completed that process they then needed to have the self-confidence to realise that this set of facts – symptoms and physical signs – does not fit any recognised disease state.

In the slide I set out the very limited research that shows the medical history is all-important. This to draw the teeth of any criticism of my speculating on what diseases Van Eyck may have painted in The Virgin with the Canon. I clearly have never met any of those depicted in that painting and have not taken their history and my examination is limited to inspection of what an artist noticed and contemporary records from The Cathedral of St Donatian.

The second question:  so, had no-one else ever noticed the disease before?

Yes they had – probably.

Jonathan Hutchinson[iii] (1890) in The Annals of Surgery where he published his case records:

“…an old man named Rumbold, the father of a well-remembered beadle at the London Hospital College....He was...quite bald....he had had red 'streaks on his head' which were painful and prevented his wearing his hat. The 'red streaks' proved on examination to be his temporal arteries, which on both sides were found to be inflamed and swollen. The streaks extended from the temporal region almost to the middle of the scalp, and several branches of each artery could be distinctly traced. The condition was nearly symmetrical. During the first week that he was under observation pulsation could be feebly detected in the affected vessels, but it finally subsided, and the vessels were left impervious cords.” 

Importantly, he also records that after this event Rumbold lived for several years and was well.

Temporal arteritis was known about in The Mediaeval period, In 1988 Ross[iv] recognised Temporal Arteritis from Casey Wood’s 1936 translation of The Memorandum Book of a Tenth-Century Oculist: The Tadhkirat of Ali ibn Isa (c. 940-1010 AD)

 "On Excision of Arteries and their Cauterization:  one treats not only migraine and headache in those patients ….including those showing heat in and inflammation of the temporal muscles. These diseased conditions may terminate in loss of eyesight….".

Artists have developed conventions to depict blindness and these were discussed in The Iconography of Blindness, a Gresham College lecture a few years ago by Professor of Physic Will Ayliffe[v]. He listed these conventions that include:

“Spectacles, particularly with dark lenses.  Blind eyes depicted as closed, whitened or asymmetrical.  Hollowed out sockets or eye being touched… The stance of the subject ... painted with arms held out feeling their way around, with an unsteady gait… with an uplifted head or wearing a broad brimmed hat.”

The attention to detail of some artists allows us to recognise features of temporal arteritis as well as severe visual loss in their subjects. 

Visual Loss Due to Temporal Arteritis 

In 1990 Applebloom[vi] reported on the bas-relief of the harpist from the Tomb of Pa-Aton-Emb-Heb (1350 BC).  The harpist (top centre) shows the usual “shadow” above his left ear, but this is continued forward onto his temple. Applebloom wondered whether the harpist's blindness (recognised by the uplifted head and eyes) resulted from temporal arteritis associated to Polymyalgia Rheumatica:

“The harpist’s eyes are closed with swollen lids, and the harpist appears to stare into space; he is round shouldered with a very wasted face, his temporal area is heightened and hollowed by a broken line joining the extremity of the eyebrow with the corner of the eye. These details are not found elsewhere.”

He detailed a statistical evaluation that supported this view.

Only a little later than Van Eyck are Piero di Cosimo’s Portraits of Giuliano and Francesco Giamberti da San Gallo. Giuliano da San Gallo, (the son) was architect and master builder to Lorenzo de’ Medici and commissioned di Cosimo after the death of his father in 1480.  Di Cosimo probably used a death mask for the father’s image.

Francesco is shown as an old man with sunken cheeks. He has prominent blood vessels on his temple. Again the uplifted head and eyes staring into space.

Who was Joris van der Paele?

He was the illegitimate son of Jan, born in Bruges in 1370 and died there in 1443.

The Council of Poitiers in 1078 had put a ceiling on his ambition by prohibiting the ordination of the illegitimate.  Van der Paele wears a surplice, but was no cleric.

He attended Bruges St Donatian Cathedral’s chapter school, which educated the intelligentsia of Bruges. In 1394 Jean Gerson, former Chancellor at the Sorbonne and a leading theologian, was appointed as Provost by Philip the Bold – raising the intellectual level and reorganising the library.

When Van der Paele was 17, Pope Urban IV appointed him as cannon – secular scribe – at St Donatian’s Cathedral. His uncle Jodicus had been a cannon there since 1364, his brother, also Jodicus, was cannon-candidate but died in 1413.

He did not perform any of the duties of the ordained: he did not say mass or hear confession and was exempt from The Council of Poitiers’ other statements on church discipline, including the enforcement of clerical celibacy.

In 1394 Van der Paele was dismissed from St Donatian’s Cathedral because of his loyalty to Rome at the time of the Avignon schism.  Bruges had sided with Avignon; Van der Paele lost his income.  It seems likely he learned from this experience, as he subsequently gained other offices and prebend incomes from far-flung parishes where he was not resident.

In 1396 he was appointed as scriptor to The Papal Curia in Rome.

There were many facets to his early career including diplomat, envoy and, possibly, spy.  For his diplomatic activities he “earned” a number of benefices.  Benefices are the once granted then life-long "fruits of office".  Money from these supported those favoured by The Catholic Church.

Van der Paele had little or no contact with the communities that provided for him throughout his life.  The accumulation of endowments brought him power and wealth.

In 1410 he was re-appointed to The Chapter of St Donatian’s Cathedral through “the anti-Pope” John XXIII – described as "utterly worldly-minded, ambitious, crafty, unscrupulous, and immoral, a good soldier but no churchman“. Some feel this description could also apply to Van der Paele

With the appointment of Pope Martin V – the next pope recognised as such by the entire western church – Van der Paele left Rome, and in 1418 returned to Bruges.  From 1420 until 1431 he attended the choral service regularly and was described as “Master of the Matins”.  Usually this implies academic qualification but in his case the title may have been honorary, as there is no record he attended university, nor that he had any musical ability.

Van der Paele’s Infirmity as Painted by Van Eyck

A Vicarious Clinical Inspection

Van Eyck's realistically paints accurate details that allow us to come to some clear views on Van der Paele’s health (see box 1):

Box 1: Features of Canon Van der Paele


divergent strabismus





skin abnormalities

several cellular moles on the cheek,

a sebaceous cyst on the left ear

[a lip epithelioma was obliterated by

restoration of the painting in 1934]

left temporal region. 

Prominent arteries

Scar formation

loss of hair in front of the left ear

loss of eyebrows.


chronic sclerotic oedema of left hand

wrinkled and stiff looking  as occurs in rheumatism

hand clawing is feature of  long-standing shoulder pain or shoulder-hand syndrome - seen in PMR,

Van Eyck painted the canon’s spectacles, which are unusual to see in paintings of the time.  It is telling that Van der Paele had the resources to obtain them but has no use for them and is shown discarding them because he can’t see.  We know that because he follows the convention of looking up to where there is nothing of any interest to see.

His eyes have diverged. In context, once vision is lost in one or both eyes, the mechanism that “locks them on the target” is lost and they diverge. This can be exaggerated in upgaze.

There are reasons to think he also has PMR. He holds his breviary awkwardly. I get the sense it is held in this way because it would be painful to hold it any other way.  His left hand is swollen and clawed, suggesting dependent oedema, or water logging, resulting from continually holding it in this position because it would be difficult or painful for him to have his shoulder and arm in any other position. Rather than grip the breviary he rests it in his clawed hand.

When we compare his face to The Harpist and Francesco Giamberti da Sangallo there are striking similarities.

Faced with dreadful physical health he would have been prone to adverse psychological consequences and a grief reaction is common.

Van eyck paints his face as showing the full sadness expression; because Van der Paele is blind his eyes are not downcast but follow the upward looking convention.

Medical History

I will now consider what is known of Van der Paele’s medical history.

His illness was established by 1431 and the Acta Capituli

[vii] [The Minutes of the Cathedral Chapter] records a 12 year duration.  He first started having difficulty attending the morning service (PMR is worse in the morning).

This is an extract from the record of the 13th November 1431 (Acta capituli, register D, folio 194 verso).  

“domini mei decanus et capitulum

precoperpunt Sigero Toor, tabulario

distributionum chori,

quod ad lucrum matutinarum

magistrum G. de Pala, canonicum, inscribat quotienscumquo

idem magister G. ad matutinas venent,

licet usque ad finem non perseverett.”

My lords the dean and chapter

instructed Sigerus Toor, accountant of

the apportionments of the choir,

that he should put down for payment the master of the matins, canon G. de Pala, however often the same master G. will have come,

granted that he may not always continue to the end

The problems continued and nearly 3 years later on the 9th September 1434 (Acta capituli, register D, folio 218 verso) further feebleness was recorded:

“Gratia rnagistro Georgio de Pala.

Die Jovis IX septembris, domini mei

decanus et capitulim indulserunt magistro Georgio de Pala

quod, attenta infirmitate et senectute suis, inscnibatur ad omnia lucra,

sive veniat ad ecclesiam sive non”

A dispensation to George de Pala.

On Thursday 9 September, my lords the

dean and chapter granted to master

George de Pala

that, in view of his feebleness and old age, he should be put down for all payments,

whether he comes to church or not.

At this time he contracted Jan Van Eyck to make the painting we know as The Virgin with The Canon. In my view this because he had PMR and had completely and suddenly lost his vision.

Detailed written contracts were usual and included details beyond just payment. If a copy of the contract remains I know nothing of it. We will speculate on the contract later.  The painting was finished in 1436.

In July 1437 the records again speak of an ongoing illness (Acta capituli, register D, folio 244 verso).

“Gratia de Pala.

Eadem die, idem domini mei, attendentes

continuam egretudinem magistri

Georgio de Pala, ad eius supplicationes

indulserunt sibi quod non foret

de necessitate astnictus coniparere in

octavis apostolorum et die proxima

capitulare sequente,

gratia tamen alias sibi facta in suo robore permanente.”

Dispensation to de Pala.

The same day, my same masters, taking

into account the continuing sickness of

master George de Pala, granted his request

that he be not of necessity obligated

to appear at the octave of the

apostles and the next chapter day following,

with however the dispensation previously

given to him remaining in force.

From February 1437 until 1443 Canon Van der Paele is mentioned in the half-yearly Chapter updates as "infirmus". He died August 25th, 1443 aged 76, in an era when male life expectancy (in the UK at least) averaged 31 years – longevity is in keeping with Temporal Arteritis.

I hope you will agree that, after considering the evidence, it is reasonable to conclude that Van der Paele had features of both Temporal Arteritis and PMR.  He was almost certainly blind and suffered a chronic illness that merited official intervention and provision of support.

The Acta Capituli fails to give any specific details of Van der Paele’s condition and does not mention that he is blind or crippled or why interventions were needed. 

In my view, this is no accidental omission but reflects how negatively his medical condition would have been considered in the Middle Ages. It may have been embarrassing if the details of the prominent Canon’s illness to become common knowledge.

How Van der Paele’s Blindness would have been Interpreted

There was a tension between church and state in medieval life during Van der Paeles time The Church’s was predominant. There was a conformity in how life was conducted that resulted from the belief that life’s whole aim was salvation: deliverance, by God's grace, from bondage, sin and condemnation and transference to the kingdom heaven with eternal life in the sight of God[viii]. 

The idea of a Chain of Being and a divinely ordered, appointed place and function for every individual was generally accepted; any disturbance of this plan was due to sin.  This divine synthesis – as expressed by Thomas Aquinas in Summa Theologica –  was usually the last word on the matter (there were dissenters such as William of Occam, who separated reason from theology).

There had been a change from classical times, when blindness was seen as neither glorious nor dismal.

In Leviticus (19:14) The Bible says “Thou shalt not curse a deaf man nor put a stumbling block before the blind but shalt fear thy God: I am The Lord”. 

By mediaeval times blindness had come to be seen as a punishment for sin particulalry fornication and avarice. The blind were treated with skepticism and considered deceitful. People of the time suspected they could see; with some reason as the mediaeval beggars’ street cry “can’t see a thing” was not literally true - 90% of the severely visually impaired will have a degree of residual vision.  Examples of the belief in the dishonesty of the blind are widespread and justified the mistreatment of those whose sight was impaired because of their sinfulness. 

In the oldest surviving French Farce, The Boy and The Blind Man. The man is wealthy: his income from begging exceeds what he could make from honest toil. He is dependent for navigation on others and employs the boy to guide him. The boy sees no reason to behave honestly and covertly abuses him – disguising his voice before beating him; stealing all his gold and possessions. This would have been seen as correct treatment on the boy’s part. Because of the blind man’s inherent duplicity – a little inconsistent as the plot depends on the blind man not seeing or being aware of the deceptions – he deserved to suffer the consequences of blindness.

A 13th century embroidered roundel on a similar theme shows the miracle of St Martin, curing both the lame man and the blind man. The lame man carries a large purse. He looks lean, but the blind man seems to be getting sufficient to eat – obese despite walking and carrying the lame man. They have formed a symbiotic relationship.

Permutations of this relationship were the subject of many mediaeval stories and plays written to instruct and entertain. The lame man abuses the blind; they are seen as enactment of god’s will. 

In one variation the blind man appears after the crucifixion and represents the figurative and literal blindness of the Jews. In another the meeting with St Martin is a mistake – the pair had been trying to avoid the saint, for fear of a cure and so losing their livelihood from begging.

The Romance of Alexander by De Grise in 1339 is held in Folio 74v at The Bodelian Library Oxford and appears with their permission:

It describes The Game with the Pig described in The Journal of a bourgeois of Paris[ix] 

“The Saturday before the Sunday, four blind people were led, behind a banner of a pig and a man playing a bass drum.

On the Sunday, they were armed each with a stick and put in a park. There was a strong pig that they could have if they killed it.”

A strange battle ensued because “they gave each other many great blows with the stick…when they believed…they hit the pig they hit each other and had they been armed would have killed each other”[x].


Sudden Blindness as a Punishment for Sin

Van der Paele had been struck suddenly blind at a time when blindness was considered to be punishment for sin.

The Fourth Lateran Council quoted John 5:14, after Jesus had healed: “Go and sin no more” as part of regularising confession, “when physicians are called to the bedside of the sick, before all else…call for physicians of the soul…so after spiritual health is restored…bodily medicine may be of greater benefit, for the cause being removed, the effect will pass away..”

Following the Synod of Paris, from the 12th century onwards, the laity took communion only by sight – not ingestion.  At ‘The Elevation’, the consecrated bread was raised and made visible to the congregation, who then could see the body of Christ.  The blind were excluded from truly seeing the elevation of course, and therefore marginalised.  If they could clearly see the host they were not blind.

St Augustine

[xi] was said to teach that those who see the host will have sufficient meat and drink; their idle oaths will be forgiven; they will not die suddenly; they will not go blind.  

Gilles le Muisit, who lived in the Benedictine abbey of St Martin from 1289, mentions his joy on again being able to see the elevation after cataract surgery. This contrasts with selective blindness for the elevation in those who attempt to see it having sinned but not confessed.

In the 13 century French manuscript Les Costumes de Tolouse shows Judicial Blinding. The magistrate in the red hood and blue gown is using a red hot poker to blind a man whose hands are shackled

St Thomas a Becket was said to have discussed the appropriate punishment for law-breaking clerics with Henry II: initially according to canon law by defrocking; but for subsequent law-breaking the king’s law: blinded, flayed or hanged, according to the kings will[xii].

Sexual sins received a great deal of attention in medieval texts and blindness was seen as an appropriate punishment.  

The 8th century Royal Abbess Friedeswide attracted the attentions of a nameless king, who pursued her despite knowing she was devoted to Christ and the preservation of her virginity. She prays for “protection of herself and punishment for her persecutor”[xiii] and a divine blow strikes him blind as he passes through the town gate of Oxford.  

Chaucer’s Merchant’s Tale is particularly instructive, as it concerns pilgrims (Bruges was a pilgrim port) avarice and sexual shenanigans amongst the retired.

It describes the relationship between January, a retired Lombardy knight who had both “greet prosperite” – Lombards were both Christian and moneylenders –  and May, his younger, sexually accommodating, wife.  January built a garden, where the couple would do things which were not done in bed, which was to become his earthly paradise.  January believed a man could do nothing sinful with his wife.

Unfortunately, because of his previous excessive sexual passion for his wife and his sexual inventiveness he is blinded by Fortune.

May deceives him, stealing and copying the key to the garden.  January’s servant Damian uses the key to enter the garden and hides up a pear tree.  Poor blind January then unwittingly helps May climb up into the pear tree where, opportunistically, Damian “Gan pullen up the smok, an in he throng”.

January’s his sight is restored at the moment his wife is penetrated by Damian and he confronts her “He swyved thee, I saugh it with myne yen”.  He is then able to find solace in denial as May successfully convinces him that his eyesight is deceiving him and she was only 'struggling with a man' to get January’s sight restored.

Sexual licence was a feature of pilgrimage.  St Boniface, when Pope, complained in a letter to Archbishop Cuthbert around 750 because there was “Scarcely a city in Lombardy or in Gaul where you could not find several of these English pilgrims turned prostitute”.

The church’s attitude to prostitutes was often pragmatic.  As Augustine of Hippo said: "If you expel prostitution from society, you will unsettle everything on account of lusts“.  St Thomas Aquinas talked of “the sewer in the palace”; remove the sewer and the whole palace will fill with corruption.

Others put these thoughts into action: In 1161, Henry II had signed into law his Ordinances Touching the Government of the Stewholders in Southwark Under the Direction of the Bishop of Winchester, regularising prostitution in Southwark. (A stew was a bathhouse where prostitutes worked.) 

In 1309 Bishop Johann of Strasbourg built a new brothel for the city as an investment.

An illuminated manuscript commissioned by an illegitimate son of Philip the Good from the painter Master Anthony of Burgundy probably depicts a Bruges stew.

A musician plays the lute, there is a dancing, veiled women wear elaborate jewelled necklaces, a magistrate (red hood - blue gown) and the king look on.

Fornication was sinful but sexual licence was openly tolerated in Flanders.

In nearby Ghent so much so there was no need for prostitution or brothels.

In Bruges, recorded fines levied on brothel owners give an indication of a flourishing trade. The relevant mediaeval law of “committed evil” is directed at the owner of the property rather than the client or service provider.

In Bruges vice flourished as nowhere else in northern Europe.  The city was notorious. The authorities never tried to control the trade in the manner of other European cities.  Prostitution was not confined to red light areas and there were no rules on clothing to distinguish prostitutes from virtuous women.

Medieval Bruges was the cradle of capitalism

[xiv]. It had a stock-exchange and a robust system of non-coin monetary exchange. Women – both married and single - could borrow money, own property and run businesses.  The port teemed with pilgrims, foreign merchants and a large population of unmarried men with money.

Women were said to outnumber men in late 1300s Bruges.  Single women moved from the countryside for low paid work as servants, or in the cloth trade, as well as to live in beguinages (a contemplative spiritual life for those not in holy orders).

These were all recruiting grounds for prostitutes.

Court records indicate inmates of beguinages and, intriguingly, nunneries attracted fines for prostitution. Many of the court documents for cases of owning and running brothels name women as defendants.

There were Institutions to reform prostitutes within nunneries: The Filles de Dieu.

Within St Donatian’s parish – Van der Paele’s parish – interestingly, no brothels are identified nor are there any court records of fines levied in the late 1300s or early 1400s.

We cannot know if Van der Paele was influenced in any way by January’s cure, or by tales of righteous blindings where sight was then miraculously restored following atonement.

John of Wermuth was blinded for working on Sunday but his sight restored following pilgrimage to The Tomb of Godric.

Mary Magdalen

[xv] restored sight to a man who misused the light of a feast day. The blind man had heard she would intercede and vowed to visit her shrine if she did. She cured a blind girl when her mother prays to her, but re-blinds her when the vow of pilgrimage is broken. The negligent mother repeats the vow and sight is again restored. Although this apparently contradicts Jesus’ views on parental sin, a Freudian may have another interpretation.

Jean Count of Luxembourg - The Blind King of Bohemia - suffered injury to one eye crusading in Latvia but developed inflammation in both – suggesting sympathetic ophthalmia. I have heard conflicting explanations based on a strong family history of eye problems. Like several of his family he was nick-named Aveugle.

Jean first consulted a Frenchman who made the problem worse. The doctor was sewn into a sack and thrown into The Oder river. An unidentified Arab doctor treated him only on condition of protection from his anger - this seemed wise.

Jean de Chauilac treated him only medically despite recognising cataracts. Eventually he became completely blind but decided to behave as though he was sighted -and was able to manage his deeds in a manner that made him appear sighted

Mediaeval medical texts are much less optimistic about reversing blindness than religious accounts. We have already mentioned Ali Ibn Hassan – he had a considerable influence on mediaeval ophthalmological thinking – especially the necessity of clear humors of the eye. In practical terms, cataract surgery excepted, interventions were not scientifically based. They included salves of swallow’s blood, aloe, opium, or mothers milk destined for a male child – St Remy’s mother cures a blind priest in that way.

Van der Paele: Motives and Opportunities

In 1410, aged 40, Joris Van der Paele retired from a successful career, first as a scribe then as a diplomat. From 1420 he was described as “master of the matins” (the night-time liturgy ending at dawn) at St Donatians in his home town Bruges.

Master implies academic qualification but in his case there is no record he attended university or had any musical abilities.

Doubtless he enjoyed the financial rewards and shared these with his family and his friends. Other than knowing he is not in holy orders and so would not carry other clerical burdens, we know little of what he got up to until he became ill aged 61 in 1431. In my view within a month or two of onset of his illness he would be likely to become completely blind and immobile.  If temporal arteritis patients survive the first 4-6 months of the illness life expectancy is not affected.

We now understand what the explanation for his problems in mediaeval times would be God’s punishment for avarice or fornication – in a city renowned for commerce and prostitution.

Modern medicine really has no better explanation and most texts say “aetiology unclear”, perhaps with that old standby an “abnormal immune reaction following a minor infection” directed against elastin – a protein common to both the joint capsule and medium to large arteries.

Van der Paele may have attempted to conceal his visual and mobility problems because of their implications but I doubt he would have been successful. I believe he had the economic resources to have explored remedies and we do know he used his wealth to benefit St Donatian’s Cathedral and to commission Van Eyke.

Jan van Eyck

Jan van Eyck was the leading artistic figure of 15th century Netherlands, a painter credited with being the founder of the “Flemish Primitives”.  His new style of art revolutionised painting.  It was distinguished by:

highly realistic figure painting, usually on religious subjects;portrait art, with three-quarter pose of the face;mastery of oil paints on wood;realism.

He was an educated free-thinking man, an envoy and possibly, like Van der Paele, a spy.  He was quite the prankster –  his self-portrait’s frame is inscribed 'Als Ich Can' –   ‘as I (Eyck) can’.  His pictures show realism, but often with magical, surreal qualities.

His patron was Philip the Good, an important figure in Europe at that time.

Philip sent Van Eyck on secret missions: in 1427 to contract a marriage for Philip with Isabella of Spain that was unsuccessful; in 1428–29 he joined the mission to seek the hand of Isabella of Portugal. He may have participated in the negotiations and he brought Philip a portrait of Isabella.

Philip wears the order of the Golden Fleece – he founded this to celebrate his marriage to Isabella of Portugal. Most European monarchs, including Queen Elizabeth II of England, are members of the order.  It was based in St Donatian’s Cathedral, Bruges.

In 1431 Van Eyck lived in Bruges and married. Having finished Van der Paele’s commission in 1436 he made another secret voyage for Philip.

Van Eyck was commissioned by many wealthy people who had links with Philip the Good.  During 1444-6 Philip spent 2% of Burgundy's tax income with the Italian cloth merchant Giovanni Arnolfini who supplied him with silk and cloth of gold. 

The Arnolfini double portrait is laden with symbolism: a man mourning a dead wife, who is likely painted from a death mask. Van Eyck – post-modern before there was modern – breaks down the 4th wall with his own reflection in the mirror and his graffiti: Jan van Eyck was here.

Nicholas Rollin was Philip’s Chancellor and commissioned a painting from Van Eyck, an example of a commission under a legally binding written contract to guarantee value.  The contract covered the quality of the materials, the master painter’s involvement, completion date, price and the subject matter.

(The contract for The Coronation of The Virgin By Caronton contains 26 paragraphs stipulating what was to be represented[xvi] including “…there should not be any difference between [God] the Father or the Son” - who are both shown crowning the virgin - probably at the request of a theological advisor.)

In the sacred conversation depicted in Rollin’s painting, all parties seem equal.  Despite kneeling, Rollin is on a level with Jesus and Mary. He is painted in the most expensive clothing though we know from x-ray studies that Van Eyck painted out a large purse from the hip of this wealthy man, probably at his request.

What the Virgin with the Canon says

Van der Paele’s commission was a conversation of another sort. He would never have seen this painting.  Van Eyck could have painted whatever he wanted to had he been of the mediaeval mindset that the blind were to be ridiculed and cheated; he could have made Van der Paele look foolish and exposed his sin to the world.  I think he behaved honourably and painted in accordance with his instructions on the biblical and theological issues depicted.

The setting is cramped and enclosed. When you stand in front of the picture you seem to be in the room with them. Everything seems very real – there is currently a Perspex safety screen in front of the picture and you can see finger marks on it, where people have perhaps tried to touch the convincing pile of the carpet.

If you stand to the left or the right of the picture there is an illusion that makes it seem the carpet is still straight ahead, drawing you in.  There are windows but we see nothing of the outside.

Mary or the infant Jesus speak first, through the parrot Jesus holds.  Parrots were thought in medieval times to say “Ave” – the greeting “Hail”.

Mary holds flowers: the red are carnations, or nagelbloem (nail flower), because they resembled the serrated edges of a medieval nail. The white flowers are mustard, the Latin name for which is Cruciferae.  Jesus looks troubled, careworn and old beyond his years.  He is hearing a familiar tale of regret for veniality while knowing his own suffering is yet to come.

St George (in catholic tradition George is Van der Paele’s Christian name) looks apprehensive and replies (written on his armour) “ADONAI” meaning  “Majesties”. His gesture says “please allow me to introduce George Van der Paele”. He makes sure Van der Paele stays on his knees by standing on his surplice so he couldn’t get up even if he wanted to.

St George is one of The Fourteen Holy Helpers, an idea that arose around the time of the great plague.  These saints were venerated  in Roman Catholicism because their intercession was believed to be effective in obtaining relief from disease.

Van Eyck had included adonai in the Ghent Altarpiece in the AGLA tile.  This is

an acronym of the Hebrew meaning “The Lord is mighty forever.”  We know he was advised by a priest on the correct biblical symbolism for the Ghent Altarpiece. The unusual circumstances and enormous time expended on this huge masterpiece have raised suspicions that Hubert van Eyck changed his name to Jan when he was inducted into an underground society.

The implication of this is that at the time of the popes and antipopes, clerical avarice and fornication engendered widespread disgust, ultimately leading to Luther's proclamation.  I mention this only to completely undermine my theory that the painting serves Van der Paeles ends: Van Eyck may be “outing him” without him realising.   But as I say, that is not my opinion.

St George was in the Guard of The Roman Emperor Diocletian. He was a Christian of the utmost probity; who would not offer a sacrifice to Roman gods even to save his own life. Initially he was bribed with inducements including land, money and slaves but this caused him only to give his wealth away. He was then tortured on a wheel of swords during which he came back from the dead three times. He was finally decapitated. Van der Paele may be drawing favourable parallels with his name-sake.

Roman Catholics who have sinned and wish reconciliation with God do so by the sacrament of confession to receive absolution. It includes contrition, confession, satisfaction and absolution.  Contrition requires sincere remorse: enumerating the ways and errors that occur when breaking God’s laws.

In this painting Van de Paele is abjectly confessing: on his knees even though this would be painful and difficult for him. He is sincerely acknowledging, and detesting his sins, which include avarice and sexual misconduct. As he was not a cleric, he was not required to be celibate so presumably his sexual sins are of an unusual nature. In doing all this he is admitting he has failed to live as a true Christian.

His purse is unmistakable, in contrast to Rollin, who had his painted over. Rollin’s purse was triangular, but Van der Paele’s is curiously phallic and hangs in an anatomically convincing way in front of his groin.

In this analysis the important matters are closest to him. We have already dealt with the discarded glasses and the breviary he can neither hold easily nor read.  Next nearest to him is Eve: “The serpent beguiled me, and I did eat”. Having eaten the fruit and gained the knowledge she turns her attention to tempting the man.

Van der Paele may be saying “I am what you, God, made – this is how men are; it was beyond my control”.

Above is Samson.   Not Daniel as has been suggested – the hair gives his identity away.  I am cautious in putting forward current understanding of many Old Testament events and the understanding in the early 14 hundreds may have been different.

In Judges 13 we are told Manoah’s wife was unable to conceive and The Angel of the Lord appeared and promised a son who would be Nazarite: dedicated to God, abstaining from wine and spirits, not cutting his hair or shaving.  The bible is silent on any stipulation of celibacy.  This man was to serve god by destroying the Philistines and he was given the strength to do so.  He was married after dismembering the lion but gave his Philistine wife to a friend. Later on he stays with a harlot in Gaza.

Samson’s fall is due to his love for Delilah leading to their sexual congress.  Delilah is not identified in the bible as a harlot, but for money will discover the secret of his strength and betray him.  As painted by Rembrandt, she exits the tent, holding the shears and Samson’s hair as he is blinded by soldiers stabbing him in the eyes.  Later he fulfilled his destiny by bringing the temple down on the philistines

One would think that this would mean automatic salvation for Samson, but as is the case for all who died before the coming of Christ, In The Roman Catholic Church the matter has not yet been decided.  On the day of judgement at the end of the world Samson’s grave will open and he will have the opportunity to learn the good news and to accept God’s love and thus salvation despite the sins that merited blinding.

Van der Paele may be saying if this is open to him, why not for me?

Adam is carved on the other side of the throne.  Both the first man and the first man to lose everything because of a woman’s intervention. “The woman whom thou gavest to be with me, she gave me of the tree, and I did eat”.

Again a message to the infant Jesus that he really ought to accept his share of the responsibility. Above Adam are his twin sons, Cain caught in the act of killing Abel. 

God cursed Cain for murdering his brother. When Cain attempted to farm the land, the earth would not yield produce for him. Cain is described, uniquely in the bible, as a fugitive and wanderer. Eventually Cain complained his punishment was greater than anyone could bear.  God put his mark on Cain in order to warn others that killing him would provoke the wrath of God.

Van der Paele seems make the same point as Cain and with some justification: completely blind and immobile with long years still ahead of him; this his punishment is greater than anyone could bear.

There are a number of Old Testament details relating to Abraham capping the columns that may be relevant – the meaning of others is obscure:

There is Abraham’s sacrifice Isaac. Bob Dylan sets out a simple explanation of what happened in Highway 61 revisited.

“Oh God said to Abraham, “Kill me a son”
Abe says, “Man, you must be puttin’ me on”
God say, “No.” Abe say, “What?”
God say, “You can do what you want Abe, but
The next time you see me comin’ you better run”
Well Abe says, “Where do you want this killin’ done?”
God says, “Out on Highway 61””[xvii]

It seem God was putting Abraham on –  Abraham went along with it in a way that was no credit to either of them – and the innocent suffered.

The Angel who put a stop to the fiasco wept tears that entered Isaac’s eyes.

Isaacs’ blindness later in his life was thought to be due to the Angel’s tears.

Van der Paele may be drawing a parallel with his own situation; blindness as the fall-out from being caught in the middle of a quarrel between the powerful.

Abraham is another who had many sexual partners judging from the 8 sons he fathered with 3 women.  First with Hagar the Egyptian handmaid of his apparently barren wife/sister Sarah.

In this painting he is preparing to “go unto Hagar” egged on in a “threesome” with his wife.

Then his heir Isaac with Sarah when he was 100 and she 90.

Then six more with Keturah after Sarah had died.

Van der Paele may be emphasizing his earlier point; this is how men are, and it’s not incompatible with serving the Lord.

Abraham defeats The Elamites in The Battle of the Vale of Siddim and meets Melchizidek who provides bread and wine and gives him 10% of the plunder.

He also meets Bera, King of Sodom who also offered him plunder but Abraham refused saying "I swore I would never take anything from you, so you can never say 'I have made Abraham rich.'"

Again a possible parallel with Van der Paele situation; riches were accepted from a ruler of somewhere considered righteous but refused from the ruler of a town notorious for toleration of shocking sexual license.

Events unfolded further; God and his 2 angels appearing as men appeared and eat with Abraham and Abraham confirmed God’s understanding of the situation in Sodom. Abraham statistical debated the notion of proportionality with God who sent his Angels to visit Abraham’s nephew Lot in Sodom. A crowd of their would-be lovers gathered.

In quick succession;

The visitors declined Lot’s offer that they accept his virgin daughters as a substitute for the Angels.

The visitors are struck temporarily blind to prevent an appallingly sin,

The Angels fail to find the agreed righteous man that would mean Sodom would be spared

Guerrieri (1617) shows Lot and his daughters preparing to leave Sodom.

- Lot’s slumped shoulders,

- the girls lacy décolletage 

- both dressed in keeping with an event that didn’t happen.

Sodom is destroyed by fire and brimstone, Lots wife looks back and is turned into a pillar of salt and the remaining 3 flee to the mountains.

Lucas van Leyden then shows foreplay: Lot apparently seducing a daughter who holds a bowl while the other daughter pours more wine.

The King James Bible (Genesis 19) puts the onus on the daughters:

“And the firstborn said unto the younger, Our father is old, and there is not a man in the earth to come in unto us after the manner of all the earth. 

Come, let us make our father drink wine, and let us lie with him that we may preserve our family through our father”.

The interpretation that Van der Paele may have understood of these events and imparted to Van Eyck can not be assumed to be the same as our own.  Although the exact details are key one can reasonably draw an inference that Van der Paele may be saying – it’s not fair. God’s judgement of sexual sin is inconsistent; context-specific and depended on the identity of the sinner. Lot and Abraham were always considered righteous despite their actions – this must prompt speculation on what was in the background. Just what had Van der Paele had been involved in, and on who’s authority?.

Above St Donatian are camels, reminding us of Matthew 19:24:  “…And again I say unto you it is easier for a camel to go through the eye of a needle, than for a rich man to enter into the kingdom of God”.

St Donatian demonstrates the substance of Van der Paele’s penance. This is the 3rd stage of the sacrament of confession: satisfaction.

The penance comes after what has been confessed, reparation to make the situation better.  Consider the likely value of the gold cross and the silk and gold thread cape, painted as heavily jewelled and embroidered with the 12 apostles.  Van der Paele’s wealth is given back to the institution that gave him much.

These bequests were approved at the highest level in the Church. In his 1438 Bull, Pope Eugenius IV says Van der Paele “hoped to exchange terrestrial and temporal goods for celestial and eternal ones in order to secure salvation.”

Donatian is the Patron Saint of Bruges, a martyr and the cause of his unbaptised brother Rogatian’s martyrdom. The brothers are also known as the children of Nantes. The Roman EmperorMaximian killed them around 288-290 for refusing to deny their faith. The night before they were to be killed Donatian comforted Rogatian with the notion that as Donatian would surely be dealt with first he would make sure he bled all over him and use his blood to baptise him.

Avarice is one of the seven deadly sins, referring to an extreme greed for wealth or material gain.  Van der Paele gave much and would give away much more, but still retained his fine house in the centre of town.  We know from the inscription on the picture’s frame that he would make more bequests, including payment for prayers to be said in perpetuity for himself and his brother.

St Donatian wears an angry expression, possibly at being conjured up to appear in this painting. From his line of sight I’d say he is not directing his anger at either Van der Paele or St George but seemingly at Van Eyck’s refection in St George’s armour.

So, in summary: Van der Paele, at the zenith of his life becomes suddenly blind and crippled. In the 1400s this would have been seen as righteous punishment for sins of avarice or of a sexual nature. He apparently admits to both and fearing damnation seeks salvation through confession and making restitution.

The painting sets this out - as well as his case in mitigation.  No blessing or absolution is depicted.

Van Eyck died early, aged 51 in 1441, predeceasing Van der Paele by 2 years.  Van der Paele, as is often the case with temporal arteritis lived a long time following the start of his illness and died aged 76. Philip the Good died in 1457. All three were buried in the crypt of St Donatians, which was destroyed in 1799.  All that remains is now in the basement of the Bruges Crowne Plaza Hotel.

It’s not clear where the three men’s mortal remains now are.  As for what is described in Roman Catholicism as their “immortal souls”, this is decided but whereabouts unknown. It is not know from any Church pronouncement whether Van der Paele’s confession led to absolution and so his salvation.

It may be that only Van Eyck was prepared to give this wealthy church functionary immortality.


[i] An undescribed form of arteritis of the temporal vessels Horton, B. T., Magath, T. B., and Brown, G. E. (1932).

Proc. Mayo Clin., 7, 700

[ii] Sir David Bruce Memorial Lecture 1988

DC Morrell DC

J R Army Med Corps 1989; 135; 43—48 - downloaded 20/7/2016

[iii]  Diseases of the arteries

Hutchinson, J. (1890). Arch. Surg. (London), 1, 323

[iv] From the Tadhkirat of Ali ibn Isa of Baghdad (c. 940-1010 AD) 1 an ancient description of what may be Temporal Arteritis. 

Ross RT J Neurol Neurosurg Psychiatry 1988 51: 528

doi: 10.1136/jnnp.51.4.528-a

[v] The Iconography of Blindness. Ayliffe W.

[vi] How ancient is temporal arteritis?

Appelboom T1, van Eigem A. J Rheumatol. 1990 Jul;17(7):929-31.

[vii] Polymyalgia rheumatica with temporal arteritis, as painted

by Jan Van Eyck in 1436

Dequeker VJ. CMA Journal 1981: 124, 1597-99 

[viii] The Medieval Underworld McCall, Andrew. Sutton Publishing 2004. ISBN 9780750937276

[ix] Journal of a bourgeois de Paris. Tuetey A. Paris Champion 1881.

[xi] Lund Studies in English. Kristensson G (Ed) p85, Gleerup 1974

[xii] Gendered violence. Van Eickels K. Gender and History (online journal), 2004; 16 p 594

[xiii] Saint Friedeswide reconsidered. Blair J. Oxford Perpetua Press 1988.  (accessed 10/10/2016)

[xiv] Bruges, Cradle of Capitalism, 1280–1390 Murray JM Cambridge University Press 2005 ISBN-13: 9780521120531

[xv] Miracles de Sainte Marie-Magdalen. Gobi l’Ancien J. Paris:CNRS Editions 1996 (accessed 10/10/2016)

[xvi] The Art of the Northern Renaissance. Harbison C. 

 Laurence King 2012. ISBN: 1780670273

[xvii] Highway 61 Revisited 

Bob Dylan. (downloaded 14/10/16)

This event was on Tue, 25 Oct 2016


Louis Clearkin FRCS

Louis is a Consultant Ophthalmic Surgeon. He concentrates his practice on Presbyopia Surgery with Refractive Lens Exchange, Cataract Surgery, Meibomian Gland Dysfunction, Adult Macular Degeneration, Retinal Vein Occlusion, Diabetic Retinopathy, Uveitis and Glaucoma.

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