We may loosely estimate the medieval relapse of medical science in Latin Christendom by noting that the most advanced anatomists and physicians of this age had barely reached, by 1500, the knowledge possessed by Hippocrates, Galen, and Soranus in the period from 450 B.C. to A.D. 200. Treatment was still based on the Hippocratic theory of humors, and bloodletting was a panacea. The first known transfusion of human blood was attempted by a Jewish physician in the case of Pope Innocent VIII (1492); as we have seen, it failed. Exorcists were still called in to treat impotence and amnesia by religious incantations or the kissing of relics, perhaps because such suggestive therapy was found occasionally helpful. Strange pills and drugs were sold by apothecaries, who added to their incomes by including stationery, varnish, confectionery, spices, and jewelry among their wares.21 Michele Savonarola, father of the fiery friar, wrote a Practica medicinae (c. 1440), and some shorter treatises; one of these discussed the frequency of mental pathology (bizaria) in great artists; another told of noted men who had lived long by the daily use of alcoholic drinks.
Medical quacks were still numerous, but medical practice was now more carefully regulated by law. Penalties were prescribed for persons who practised medicine without a medical degree; and this presumed a four-year medical course (1500). No physician was allowed to prognose a grave disease except by consultation with a colleague. Venetian legislation required physicians and surgeons to meet once a month to exchange clinical notes, and to keep their knowledge up to date by attending a course on anatomy at least once a year. The graduating medical student had to swear that he would never protract the sickness of a patient, that he would supervise the preparation of his prescriptions, and that he would take no part of the price charged by the apothecary for filling them. The same law (Venice, 1368) limited the apothecary’s charge for filling a prescription to ten soldi22—coins now impossible to evaluate. We hear of several cases in which the medical fee, by a specific contract, was made conditional on cure.23
Surgery was rising rapidly in repute as its repertoire of operations and instruments approached the variety and competence of ancient Egyptian practice. Bernardo da Rapallo devised the perineal operation for stone (1451), and Mariano Santo became famous for his many successful lithotomies by lateral incision (c. 1530). Giovanni da Vigo, surgeon to Julius II, developed better methods of ligature for arteries and veins. Plastic surgery, known to the ancients, reappeared in Sicily about 1450: mutilated noses, lips, and ears were repaired by grafts of skin from other parts of the body, and so well that the lines of adhesion could scarcely be detected.24
Public sanitation was improving. As Doge of Venice (1343–54), Andrea Dandolo established the first known municipal commission of public health;25 other Italian cities followed the example. These magistrati della sanità tested all foods and drugs offered for public sale, and isolated the victims of some contagious diseases. As a result of the Black Death, Venice in 1374 excluded from her port all ships carrying persons or goods suspected of infection. At Ragusa (1377) such arrivals were detained for thirty days in special quarters before being admitted into the city. Marseille (1383) lengthened the detention period to forty days—la quarantine, and Venice followed suit in 1403.26
Hospitals were multiplying under the zeal of both laity and clergy. Siena built in 1305 a hospital famous for its size and services, and Francesco Sforza founded the Ospedale Maggiore in Milan (1456). In 1423 Venice converted the island of Santa Maria di Nazaret into a lazaretto to hospitalize infected persons; this is the first institution of its kind known in Europe.27 Florence in the fifteenth century had thirty-five hospitals.28 These establishments were generously supported by public and private donations. Some hospitals were notable examples of architecture, like the Ospedale Maggiore; some adorned their halls with inspiring works of art. The Ospedale del Ceppo at Pistoia engaged Giovanni della Robbia to mold for its walls terra-cotta reliefs vividly describing typical hospital scenes; and the façade of the Ospedale degli Innocenti at Florence, designed by Brunellesco, was signalized by the charming terra-cotta medallions placed in the spandrels of its portico arches by Andrea della Robbia. Luther, who was so shocked by the immorality that he found in Italy in 1511, was also impressed by its charitable and medical institutions. He described the hospitals in his Table Talk:
In Italy the hospitals are handsomely built, and admirably provided with excellent food and drink, careful attendants, and learned physicians. The beds and bedding are clean, and the walls are covered with paintings. When a patient is brought in, his clothes are removed in the presence of a notary who makes a faithful inventory of them, and they are kept safely. A white smock is put on him, and he is laid on a comfortable bed, with clean linen. Presently two doctors come to him, and servants bring him food and drink in clean vessels…. Many ladies take turns to visit the hospitals and tend the sick, keeping their faces veiled, so that no one knows who they are; each remains a few days and then returns home, another taking her place…. Equally excellent are the foundling asylums of Florence, where the children are well fed and taught, suitably clothed in a uniform, and altogether admirably cared for.29
It is often the fatality of medicine that its heroic advances in therapy are balanced—almost pursued—by new diseases. Smallpox and measles, hardly known in Europe before the sixteenth century, now came to the fore; Europe experienced its first recorded influenza epidemic in 1510; and epidemics of typhus—a disease not mentioned before 1477—swept Italy in 1505 and 1528. But it was the sudden appearance and rapid dissemination of syphilis in Italy and France toward the end of the fifteenth century that constituted the most startling phenomenon and test of Renaissance medicine. Whether syphilis existed in Europe before 1493, or was brought from America by the return of Columbus in that year, is a matter still debated by the well informed, and not to be settled here.
Certain facts support the theory of an indigenous European origin. On July 25, 1463, a prostitute testified in a court at Dijon that she had dissuaded an unwelcome suitor by telling him that she had le gros mal—not further described in the record.30 On March 25, 1494, the town crier of Paris was directed to order from the city all persons afflicted with la grosse verole.31 We do not know what this “great pox” was; it may have been syphilis. Late in 1494 a French army invaded Italy; on February 21, 1495, it occupied Naples; soon afterward a malady became rampant there, which the Italians called il morbo gallico, “the French disease,” alleging that the French had brought it into Italy. Many of the French soldiers were infected with it; when they returned to France, in October, 1495, they scattered the disease among the people; in France, therefore, it was called le mal de Naples, on the assumption that the French army had contracted it there. On August 7, 1495, two months before the return of the French army from Italy, the Emperor Maximilian issued an edict in which mention was made of malum francicum; obviously this “French disease” could not be ascribed to the French army not yet returned from Italy. From 1500 on, the term morbus gallicus was used throughout Europe to mean syphilis.32 We may conclude that there are suggestions, but no convincing evidence, that syphilis existed in Europe before 1493.
The case for an American origin is based upon a report written between 1504 and 1506 (but not published till 1539) by a Spanish physician, Ruy Diaz de l’Isla. He relates that on the return voyage of Columbus the pilot of the admiral’s vessel was attacked by a severe fever, accompanied with frightful skin eruptions, and adds that he himself, at Barcelona, had treated sailors infected with this new disease, which, he says, had never been known there before. He identified it with what Europe was” calling morbus gallicus, and contended that the infection had been brought from America.33 Columbus, on his first return from the West Indies, reached Palos, Spain, on March 15, 1493. In that same month Pintor, physician to Alexander VI, noted the first appearance of the morbus gallicus in Rome.34 Almost two years elapsed between the return of Columbus and the French occupation of Naples—sufficient time for the disease to spread from Spain to Italy; on the other hand, it is not certain that the plague that ravaged Naples in 1495 was syphilis.35 Very few bones whose lesions may be interpreted as syphilitic have been found in pre-Columbian European remains; many such bones have been found among the relics of pre-Columbian America.*36