The quilisma is a sign found in the earliest surviving notations of Gregorian chant. Since the ‘chant restoration’ of the nineteenth and twentieth centuries, the sign is included once again in all chant books, and poses an inevitable question of interpretation to those studying and performing chant. However, since medieval times, there has been considerable debate whether the sign denotes a particular method of voice production, a particular rhythmic value and/or an element in a melody's modal orientation. Chant manuscripts of the northern Low Countries (the northern half of the modern-day Netherlands), although not well known for their melodic content, point to highly interesting developments in response to a continually changing musical aesthetic. Likewise, these manuscripts offer new insights into the quality of the quilisma: the sign was widely used in the region up to the sixteenth-century Dutch Revolt, and for much longer than in the better-known square notation. Through analytical and comparative study, the sign's occurrence, position, development, relation to other signs and functions are clarified and presented in this article along with insights into its unique notational development.