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Doctors and Medicine in Early Renaissance Florence
By Katharine Park
PRINCETON UNIVERSITY PRESSCopyright © 1985 Princeton University Press
All rights reserved.
The society of early Renaissance Florence, like that of the other north Italian city-states, functioned less as a collection of individuals than as a network of overlapping collectivities. Some of these collectivities, like families, served a multitude of public and private purposes. Some, like guilds or partnerships, were primarily economic in character, while others met needs of political organization or defense; among these were neighborhood militias, parties or factions, and the communal government itself. Still others embodied religious ties — parish churches, monasteries, hospitals, confraternities. Although such groups differed in size, permanence, cohesiveness, and legal status, they all represented, formally or informally, an ideal of solidarity and mutual aid or protection. Medicine, too, was ordered by its corporate structures and cannot be understood in isolation from them.
The community of medical practitioners and the practice of medicine, like most of the other nonmenial occupations in Renaissance Florence, was defined and regulated by its guild, the Guild of Doctors, Apothecaries, and Grocers; this body established licensing requirements and standards which the profession was expected to observe. Thus the statutes and matriculation lists of the guild represent the official framework within which the Florentine doctor exercised his trade. But the guild was much more than a simple regulatory body: embedded in Florence's corporate order, it reflected changing economic, social, and political conditions in the city. In this way it serves as a microcosm of the forces which shaped the lives of doctors in the fourteenth and fifteenth centuries.
The Guild of Doctors, Apothecaries, and Grocers was one of the twenty-one corporations of masters established in 1293 by the Ordinances of Justice. It belonged to the group of the seven "greater guilds," which also governed law, banking, the cloth industry, and international trade. There were in addition fourteen lesser guilds with jurisdiction over the more traditional crafts and the food trade, none of which, as a rule, offered the status and income of banking, commerce, and the professions. Like other medieval craft and merchant corporations, the Florentine guilds had originated as protective associations of workers in allied trades, asserting a monopoly over those trades and aiming at the defense of common economic interests. At the same time they also had a social component; their members were bound by ties of acquaintance and kinship, and these ties were expressed in their statutory obligations to observe the funerals of colleagues, to provide for the needs of less fortunate brethren, and to support joint religious works.
The guilds also functioned as political bodies. Each had its own power structure and political constitution. Furthermore, by the late thirteenth century the twenty-one corporations defined by the Ordinances of Justice had been established as the foundation of the city's electoral system; guild membership was required for the most important communal offices. The political power of the guilds was progressively, if intermittendy, eroded beginning in the late 1320s. Nonetheless, the guilds continued to perform a variety of functions: they supplied a proving ground for political hopefuls, provided fraternal support, and regulated the many occupations on which the commercial economy of Florence depended.
These multiple functions are reflected in the statutes of the Guild of Doctors, Apothecaries, and Grocers, which in turn shaped (and were shaped by) the conditions of medical practice. The statutes illuminate not only the specific licensing requirements and regulations which governed the professional life of Florence's doctors but also the nature and limits of the more intangible sense of cohesion which bound them together and gave them a group identity. Furthermore, the various amendments to the statutes passed in the years after 1348 show in detail how the plague affected the Florentine medical profession. But statutes and amendments alone offer at best a rather abstract picture of the aspirations of the profession and the way it attempted to realize them through the guild; they must be supplemented by a variety of other archival material to yield a clear sense of how important the guild actually was in the life of the medical profession and how it made its influence felt. In this chapter we will be shifting back and forth from the ideal to the real, from statute to enforcement. The evidence is often frustratingly incomplete; nonetheless it allows us to assemble at least a fragmentary portrait of the formal and informal organization of the Florentine medical profession.
Doctors in the Constitution of the Guild
As the name of the Guild of Doctors, Apothecaries, and Grocers suggests, medical practitioners were only one of the occupational groups it governed. Most Florentine guilds shared this heterogeneous character to some degree, but the Guild of Doctors, Apothecaries, and Grocers was perhaps the most extreme example. Originally an association of spice and drug merchants, it had come to encompass a number of related trades by the end of the thirteenth century, including not only the other two eponymous groups, doctors (who also handled drugs) and grocers (who sold various other sorts of dry goods), but also a miscellaneous lot of chandlers, painters, stationers, leatherworkers, and metalworkers. Over the course of the fourteenth century a number of new occupations, including barbers and gravediggers, also made their appearance in its rolls.
The heterogeneity of its members determined to some extent the character of the guild. By the mid-fourteenth century it was probably the largest of the greater guilds, boasting a membership of roughly six hundred. Furthermore, its internal history was particularly turbulent, as its various constituent occupations jockeyed for power. The product of these struggles was a federation of diverse occupational groups with varying degrees of authority and autonomy. By 1314, the year of the guild's first surviving statute, the three subcorporations or branches (membri) of doctors, apothecaries, and grocers had assumed autonomous and equal status in its constitution. They presided in turn over an elaborate hierarchy of subordinate occupations; among these the saddlers, incorporated as a subgroup of the grocers, and the painters, a subgroup of the apothecaries, had their own statutes, although none was represented in the central administration of the guild. The federative structure of the Guild of Doctors, Apothecaries, and Grocers was confirmed in the revised statute of 1349, which, with subsequent amendments, was to govern its activities, and by extension those of the medical profession, during the entire Renaissance period.
The statute of 1349 defined both the corporate nature of Florence's medical profession (the guild's branch of doctors) and its relationship to the broader guild community. In some respects, doctors shared the general privileges and obligations of all members of the Guild of Doctors, Apothecaries, and Grocers. They participated in its common ceremonial life, attending the religious observances and banquet associated with the feasts of Mary and St. Barnabas. Like other members, they joined the guild by paying a matriculation fee and swearing an oath of obedience to the consuls, its chief officers. Like other members, they benefited from the guild's claim to monopolize the practice of their occupation in the Florentine territories. They were required to observe the common regulations concerning treatment of apprentices, rental of shops, and general honesty which governed the guild membership as a whole; accused of infractions, they were tried by the guild's six consuls in its palazzo on the Via Sant'Andrea. In case of need, doctors were eligible for the material aid which the guild offered, at least in theory, to members who had fallen on hard days, and their funerals were to be attended by a delegation of the consuls and representatives of the guild as a whole. Like the members of the other principal branches, finally, doctors were eligible for the consulship and other guild offices — as councilors, syndics, arbiters, and special consular appointees (arroti) — although by 1349, because their numbers were so much smaller than those of the apothecaries and grocers, the proportion of offices assigned to them was the smallest of the three.
In addition to these common rights and obligations, however, the statute of 1349 also contains provisions specific to particular subject trades. Chandlers had to use wax of a certain quality, for example; apothecaries could not sell or administer various dangerous drugs; stationers could not erase entries for clients seeking to falsify contracts and records. Furthermore, a special kind of social solidarity existed — or was supposed to exist — among workers in the same occupation. Thus, for example, when a painter, pursemaker, or scabbardmaker died, each workshop of his colleagues was to send a mourner to his funeral.
The rubrics of the statute of 1349 governing medical practitioners encouraged a similar but heightened sense of community among Florentine doctors. Alone of all the members of the Guild of Doctors, Apothecaries, and Grocers, for example, doctors were expected to attend the funerals not only of their colleagues but also of their colleagues' wives. Unlike other guild members, they were forbidden to speak ill of one another, either publicly or in private. This solidarity extended also to their work. A doctor could be fined for treating another's patient before the first had been paid in full. A surgeon attending a patient suffering from a cranial fracture or other life-threatening condition was required to consult a colleague. A physician called on by the communal authorities to make a forensic judgment concerning cause of death was to seek a second opinion from a surgeon, and vice versa.
Such special protective regulations, different in degree though not in kind from the regulations governing other occupations within the guild, encouraged close collegial bonds. They also reflected the special licensing requirements placed on doctors by the guild. Doctors were alone among its members in having to prove their competence before being allowed to matriculate and enter practice. The statute of 1349 spelled out the requirements. "And so that no doubt can arise over who are doctors," it read,
we declare that all persons in the city or countryside of Florence who practice physic or surgery, set bones, and treat mouths, whether they use writing or not, are understood to be doctors, and are to be held and considered doctors, and must swear obedience and submit to the guild and its consuls.
Furthermore, the statute stipulated,
no new doctor, whether physician or surgeon, who does not have a doctorate may practice the art of medicine or heal in physic or surgery in the city or district of Florence, unless he has been examined by those consuls who are doctors, along with four doctors selected for the purpose by the consuls who are doctors, and approved as competent by those consuls and the four other doctors in a secret vote conducted by the guild notary.
As in the case of the other principal occupations over which they had jurisdiction, the consuls were to discourage unregulated medical practice by fining illegal practitioners and any guild member who had dealings with them; the fine of twenty-five lire (£) prescribed for unmatriculated doctors was, however, considerably larger than the forty soldi with which the other groups were threatened. (For a sketch of the Florentine monetary system, see Appendix I.)
The requirement of either a doctorate or a practical examination set medicine apart from the other occupations governed by the Guild of Doctors, Apothecaries, and Grocers, and indeed from most of the occupations governed by the other Florentine guilds. A number of guilds imposed special conditions for admission, but these generally concerned only the moral charater of the candidate or, in the case of the Guild of Bankers and Moneylenders, his residence and solvency. The only other greater guild to ask for a demonstration of technical competence from some or all of its prospective matriculants was the Guild of Lawyers and Notaries, which required from the former proof of a university degree and from the latter satisfactory performance on three examinations. Furthermore, by 1349 approval of the prospective doctor, like that of the prospective lawyer or notary, was entirely in the hands of his own profession — of the medical professors who voted the degree, in the case of the university-trained physician or surgeon, and of the examining doctors chosen by the guild, in the case of practitioners without a degree. This was a relatively new development, since as recently as 1314 the examining board had included all six of the guild's consuls (only two of whom were doctors) in addition to "two Franciscan and two Dominican friars selected by the priors or guardians of their orders."
Thus the only two guilded occupations in Florence to demand a demonstration of competence (besides the craft of armormaking) were law and medicine. In both cases the justification was couched in terms of the elevated nature of the calling and the need to protect the public in such crucial and delicate domains; in both cases the existence of a university curriculum and a special title for its masters expressed the selective nature of the profession. Lawyers and doctors did not differ from the rest in enjoying a legal monopoly on the practice of their trades; that was the assumption which underlay the entire guild system. Their distinction was, rather, that by the middle of the fourteenth century they had gained both the right to require certain technical qualifications for guild membership and the exclusive responsibility for setting, verifying, and enforcing those qualifications. (The commune itself did not license medical practitioners, although by 1415 the Florentine statutes explickly recognized the rights of the guild in this matter.) These privileges of monopoly and of autonomy in setting licensing requirements are usually identified by Anglo-American scholars as the hallmarks of a profession and associated with the attainment of a university degree. The Florentine case suggests a more complicated dynamic: the development of a body of sophisticated theory embedded in a university curriculum may have allowed the branch of doctors to argue for special, more stringent licensing requirements; nonetheless, the institution which enforced these requirements was not the university but the guild, and the requirements did not exclude empirically trained doctors of proven competence.
Medical licensing in fourteenth-century Florence differed from later and northern European forms in setting a broad set of qualifications for legal admission to the profession. Candidates could choose between two entirely different criteria: the university degree and the guild examination. Once deemed qualified, however, all were matriculated without distinction in the books of the guild and granted the honorific tide of master (maestro or magister). As a result, the guild's branch of doctors included people of widely differing social classes and medical training, from the physician with a doctorate from Padua to the shoemaker who couched cataracts; all, however, were fully licensed practitioners.
Thus Florentine doctors, bolstered by the sensitivity and prestige of their art as well as by their relative overrepresentation in the power structure of the guild before 1349, managed to incorporate into the new statute of that year a number of special provisions designed to protect the profession's livelihood and reputation. These provisions aimed to reduce competition, establish licensing requirements and standards for practice, and multiply opportunities for consultation. In the process, they also aimed to promote a closer sense of community than obtained among the other occupations governed by the guild. In practical terms, however, the very breadth of the licensing requirements must have served to limit medical collegiality. We know, for example, that university-trained physicians sometimes objected to working with empirics; it is also hard to believe that Florentine physicians would have mustered much enthusiasm at the funeral of the wife of an illiterate tooth-doctor. Even in the ideal world of the statute of 1349, moreover, there was a rubric hinting at a special solidarity restricted to the higher ranks of medical practitioners: all physicians were required to attend disputations on medical topics at the University of Florence, if so notified by the guild. Since the university was established only in 1348, this provision did not appear in the earlier statute of 1314; it represents the beginning of a process of differentiation which was to culminate in 1392 with the foundation of a separate corporation of university-educated doctors within the guild.
Excerpted from Doctors and Medicine in Early Renaissance Florence by Katharine Park. Copyright © 1985 Princeton University Press. Excerpted by permission of PRINCETON UNIVERSITY PRESS.
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