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 Töply 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.)
“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 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 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 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 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.”
Notes
48 Studien zur Geschichte der Anatomie im Mittelalter von Robert Ritter Von Töply. Leipzig, 1898.