Maestro Francesco da Roma: Portrait of a Renaissance Public Health Officer

MAESTRO FRANCESCO DA ROMA: PORTRAIT OF A RENAISSANCE PUBLIC HEALTH OFFICER STEPHEN R. ELL* Sometime around 1330, a young Roman physician named Francesco entered the imposing Venetian seat of government, now popularly called the Doge's Palace. His mission was a serious one. In order to be licensed to practice his profession, he had to swear an oath before the officials of the Giustizia Vecchia [1, 2]. We do not know how old Francesco was, but his medical training had taken around 6 years, and typically he would havejoined a master physician no earlier than age 18 as apprentice [3]. So we may assume him to have been in his midtwenties . He was already a member of the guild of physicians, surgeons, and barbers. To enter the guild, he had, as a foreigner, to pay twice the usual fee and serve an extra year under a Venetian physician as well as being examined by a panel from the guild [4]. In the dark and intentionally forbidding chamber of the Giustizia Vecchia, Francesco dropped to one knee and swore that he would uphold the rules of his guild (these rules were themselves laid down by the Giustizia Vecchia, for Venetian guilds were controlled by the city government ), would practice ethically, and would enter into no partnership with an apothecary [5]. After this intimidating exercise, Francesco was given a license to practice medicine in Venice. Francesco was a medicus,the fourteenth-century equivalent of a practitioner of internal medicine. For 200 years, Europeans had distinguished medici from surgeons and, less systematically, the latter from barbers [6, 7]. As a medicus, Francesco enjoyed the next-to-highest status in medicine. Only doctors of medicine enjoyed more prestige. Such men occupied university posts and might enjoy a renowned career without actually laying hands on patients. Taddeo Alderotti, roughly a contemporary of Francesco's, treated many of his patients literally by mail. A *Department of Radiology, University of Chicago Medical Center.© 1986 by The University of Chicago. All rights reserved. 003 1-5982/86/2904-0497$01.00 Perspectives in Biology and Medicine, 29, 4 · Summer 1986 \ 539 sick person of means, or his physician, would address a description of the malady to someone like Alderotti and, in return for an often exorbitant fee, receive a consilium or written opinion on how best the illness might be treated [8]. Francesco, by comparison, had a much less glamorous existence. He treated patients personally and was not a favorite of the wealthy. Obliged by law to practice near the Rialto, he probably rented a modest office and lodging in that area from the city, as did most of his professional equals [9, 10]. On the other hand, medical services were much in demand in Venice, a city without a medical school of its own, and an enterprising practitioner could expect to earn a reasonable living. Between 1305 and 1348 about 5 percent of the naturalized citizens of Venice were physicians—clearly disproportionate to the number of medical practitioners in the general population. Most Venetian physicians were of foreign origin throughout the fourteenth and fifteenth centuries [11, 12]. In 1333, Francesco was hired by the senate to work for the city on a fixed salary of 10 lire per year [13]. This was part-time employment except in emergency. The Venetian government had employed physicians from at least the late thirteenth century [2]. By 1290, Venice spent 2,000 lire on such employees. Most such salaried physicians served in the fleets and in Venetian colonies. Essentially, every war gallery or small contingent thereof carried a barber who handled the wounded and made some extra money selling ointments [2, 14]. There is no evidence that Francesco ever served in the colonies, but all salaried physicians were expected to spend some time in the fleet. In Venice, all physicians were obliged to surrender to the authorities any person suspected of being a criminal [2, 15]. No respect was given the confidentiality of what passed between physician and patient. More startling from a modern viewpoint is that government-paid physicians were required to assist in the torture of criminals [2, 16]. Included in these tortures were hanging stones of up to...