Chapter XXV: Appendix: III

MEDIEVAL LAW FOR THE REGULATION OF THE PRACTICE OF MEDICINE.

It is usually presumed that the practice of medicine was on a very low plane during the Middle Ages, and that while only little was known about medical science, the methods of practicing the medical art were crude, as befitted an earlier time in evolution before modern advances had come. Any such impression is founded entirely on ignorance of the conditions which actually existed. In his studies in the history of anatomy in the Middle Ages, Von Toeply [Footnote 48] quotes the law for the regulation of the practice of medicine issued by the Emperor Frederick II. in 1240 or 1241. The Law was binding on the two Sicilies, and shows exactly the state of medical practice in the southern part of Italy at this time. Everything that we think we have gained by magnificent advances in modern times is to be found in this law. A physician must have a diploma from a university and a license from the government; he must have studied three years before taking up medicine--then three years in a medical school, and then must have practiced with a physician for a year before he will be allowed to take up the practice of medicine on his own account. If he is to take up surgery, he must have made special studies in anatomy. The law is especially interesting because of its regulation of the purity of drugs, in which it anticipates by nearly seven centuries our Pure Drug Law of last year. (This law was published in the form here given in the "Journal of the American Medical Association," January, 1908.)

[Footnote 48: Studien zur Geschichte der Anatomie im Mittelalter von Robert Ritter Von Toeply. Leipzig, 1898.]

"While we are bent upon making regulations for the commonweal of our
loyal subjects, we keep ever under our observation the health of the
individual. In consideration of the serious damage and the
irreparable suffering which may occur as a consequence of the
inexperience of physicians, we decree that in future no one who
claims the title of physician shall exercise the art of healing or
dare {420} to treat the ailing, except such as have beforehand, in
our University of Salerno, passed a public examination under a
regular teacher of medicine, and been given a certificate not only
by the professor of medicine, but also by one of our civil
officials, which declares his trustworthiness and sufficient
knowledge. This document must be presented to us, or in our absence
from the kingdom to the person who remains behind in our stead, and
must be followed by the obtaining of a license to practice medicine
either from us or from our representative aforesaid. Violation of
this law is to be punished by confiscation of goods and a year in
prison for all those who in future dare to practice medicine without
such permission from our authority.

"Since students cannot be expected to learn medical science unless
they have previously been grounded in logic, we further decree that
no one be permitted to take up the study of medical science without
beforehand having devoted at least three full years to the study of
logic." (Under logic at this time was included the study of
practically all the subjects that are now taken up in the arts
department of our universities. Huxley, in his address before the
University of Aberdeen on the occasion of his inauguration as Rector
of that University, said that "the scholars [of the early days of
the universities] studied Grammar and Rhetoric; Arithmetic and
Geometry; Astronomy, Theology and Music." He added: "Thus their
work, however imperfect and faulty, judged by modern lights, it may
have been, brought them face to face with all the leading aspects of
the many-sided mind of man. For these studies did really contain, at
any rate, in embryo--sometimes, it may be, in caricature--what we
now call Philosophy, Mathematical and Physical Science, and Art. And
I doubt if the curriculum of any modern university shows so clear
and generous a comprehension of what is meant by culture as the old
Trivium and Quadrivium does." Huxley, Science and Education Essays,
page 197. New York, D. Appleton & Co., 1896.--J. J. W.)

"After three years devoted to these studies, he (the student) may,
if he will, proceed to the study of medicine, provided always that
during the prescribed time he devotes himself also to surgery, which
is a part of medicine. After this, and not before, will he be given
the license to practice, provided he has passed an examination in
legal form as well as obtained a certificate from his teacher as to
his {421} studies in the preceding time. After having spent five
years in study, he shall not practice medicine until he has during a
full year devoted himself to medical practise with the advice and
under the direction of an experienced physician. In the medical
schools the professors shall during these five years devote
themselves to the recognized books, both those of Hippocrates as
well as those of Galen, and shall teach not only theoretic, but also
practical medicine.

"We also decree, as a measure intended for the furtherance of Public
Health, that no surgeon shall be allowed to practice, unless he has
a written certificate, which he must present to the professor in the
medical faculty, stating that he has spent at least a year at that
part of medicine which is necessary as a guide to the practice of
surgery, and that, above all, he has learned the anatomy of the
human body at the medical school, and is fully equipped in this
department of medicine, without which neither operations of any kind
can be undertaken with success nor fractures be properly treated.

"In every province of our Kingdom which is under our legal
authority, we decree that two prudent and trustworthy men, whose
names must be sent to our court, shall be appointed and bound by a
formal oath, under whose inspection electuaries and syrups and other
medicines be prepared according to law and only be sold after such
inspection. In Salerno in particular, we decree that this
inspectorship shall be limited to those who have taken their degrees
as Masters in Physic.

"We also decree by the present law, that no one in the Kingdom,
except in Salerno or in Naples (in which were the two universities
of the Kingdom), shall undertake to give lectures on medicine or
surgery, or presume to assume the name of teacher, unless he shall
have been very thoroughly examined in the presence of a Government
official and of a professor in the art of medicine.

"Every physician given a license to practice must take an oath that
he shall faithfully fulfil all the requirements of the law, and in
addition, whenever it comes to his knowledge that any apothecary has
for sale drugs that are of less than normal strength, he shall
report him to the court, and besides he shall give his advice to the
poor without asking for any compensation. A physician shall visit
his patient at least twice a day, and at the wish of his patient
once also at night, and shall charge him, in case the visit does not
{422} require him to go out of the village or beyond the walls of
the city, not more than one-half tarrene in gold for each day's
service." (A tarrene in gold was equal to about thirty cents of our
money. Money had at least twenty times the purchasing power at that
time that it has now. At the end of the thirteenth century,
according to an Act of the English Parliament, a workman received 4d
[eight cents] a day for his labor, and according to the same Act of
Parliament the following prices were charged for commodities: A pair
of shoes cost eight cents, that is, a day's wages. A fat goose cost
seven cents, less than a day's wages. A fat sheep unshorn cost
thirty-five cents; shorn, about twenty-five cents. For four days pay
a man could get enough meat for himself and family to live on for a
week, besides material out of which his wife could make excellent
garments for the family. A fat hog cost twice as much as a fat
sheep, and a bullock about six times as much.--J. J. W.) "From a
patient whom he visits outside of the village or the wall of the
town, the physician has a right to demand for a day's service not
more than three tarrenes, to which maybe added, however, his
expenses, provided that he does not demand more than four tarrenes
altogether.

"He (the regularly licensed physician) must not enter into any
business relations with the apothecary, nor must he take any of them
under his protection nor incur any money obligations in their
regard." (Apparently many different ways of getting round this
regulation had already been invented, and the idea of these
expressions seemed to be to make it very clear in the law that any
such business relationship, no matter what the excuse or method of
it, is forbidden.--J. J. W.) "Nor must any licensed physician keep
an apothecary's shop himself. Apothecaries must conduct their
business with a certificate from a physician, according to the
regulations and upon their own credit and responsibility, and they
shall not be permitted to sell their products without having taken
an oath that all their drugs have been prepared in the prescribed
form, without any fraud. The apothecary may derive the following
profits from his sales: Such extracts and simples as he need not
keep in stock for more than a year before they may be employed may
be charged for at the rate of three tarrenes an ounce." (90 cents an
ounce seems very dear, but this is the maximum.) "Other medicines,
however, which in consequence of the special conditions required for
their preparation or for any other reason the apothecary has to have
in {423} stock for more than a year, he may charge for at the rate
of six tarrenes an ounce. Stations for the preparation of medicines
may not be located anywhere, but only in certain communities in the
Kingdom, as we prescribe below.

"We decree also that the growers of plants meant for medical purpose
shall be bound by a solemn oath that they shall prepare medicines
conscientiously, according to the rules of their art, and as far as
it is humanely possible that they shall prepare them in the presence
of the inspectors. Violations of this law shall be punished by the
confiscation of their movable goods. If the inspectors, however, to
whose fidelity to duty the keeping of these regulations is
committed, should allow any fraud in the matters that are entrusted
to them, they shall be condemned to punishment by death."

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