§ 1. What was said to everyone by Ecclesiasticus, chapter 38, concerning honoring the physician has been commanded especially to the state and the prince. For it belongs to them to provide not only for themselves but for the whole fatherland, so that diseases may be encountered at the proper time and excellent physicians, surgeons, and apothecaries may be possessed. They must be maintained with such munificence that they do not wish for a crowd of sick people. And just as a prudent head of a household, when he has relieved hunger, nevertheless stores provisions for future necessity, so too let a city possess one or more physicians who may remedy private and epidemic diseases. Let it not only foster him in the state but also assign him an honored place. I shall embrace in perspicuous words what I think concerning this matter.
§ 2. Let singular honor be assigned to physicians in the state. Thus the divine writings, Ecclesiasticus 38:1: “Honor the physician on account of necessity, for the Most High created him. For all healing is from God, and he shall receive a gift from the king. The physician’s learning shall exalt his head, and he shall be praised in the sight of the great. The Most High created medicine from the earth, and a prudent man will not abhor it. Was not bitter water made sweet by wood? Their power was made known to men, and the Most High gave knowledge to men, that He might be honored in His marvelous works. By these things the one who treats shall mitigate pain, and the perfumer shall make pigments of sweetness and compound ointments of health, and His works shall not be brought to an end. For the peace of God is over the face of the earth.”
Most modern Greek copies have:
Τίμα τὸν ἰατρὸν πρὸς τὰς χρείας τιμαῖς αὐτοῦ.
“Honor the physician according to necessities with his honors.” For it does not understand an honor by which you come to his aid lest he be in want. Rather, it means that you should honor him before the necessity of disease exacts it. Thus Ben Sira expounded it. And other Hebrews command gifts to be given to the physician and honor to be imparted to him, so that, remembering them, he may visit you willingly and promptly in time of illness.
§ 3. Let the dignity and rewards of a physician in the state be so great that even nobles and magnates aspire to them. Let there be no less an approach to undertaking the state for Machaon than for Demosthenes. For why should they not entrust a part of the state to the man to whom they entrust their own life and the lives of their children and wives—
The reason why I so judge is that I consider the health of the citizens and the prince worthy of being cared for by men of the first rank. Nor is it unworthy of a noble man to visit the cottages of the poor, feel the pulse of an artery, judge the signs and criteria of diseases, and prescribe pills. It is human malice which has detracted esteem from the guardians of its health and yet surrounded the avengers of its crimes with majesty. Fasces, axes, and a lictor are added to magistrates as insignia of power, yet they are instruments of executioners. Magistrates approach prisons and command the guilty to be stretched, cut by claws, burned, and driven to the cross; and the ambitious names of judges and prefects lead to this power. Why should there be less honor for a physician, the patron of life and health, than for a judge, the minister of death? Our nature, the corrupter of order, has envied its own goods and esteems the power of destroying guilty men more than the ability to preserve a citizen. Whence comes this great evil, that the man who preserves good men is lesser than the man who destroys bad men?
I do not wish this to be said as though I wished physicians to be preferred either to jurists or to magistrates. For their own honor remains to magistrates, and no one moves the palm from its place in the order; and according to the custom of the academies, physicians yield to jurisconsults. I say it so that I may show that physicians also are to be adorned with public dignities and that nothing in their functions is to be judged base.
Nevertheless, the controversy between physicians and jurists concerning dignity of place is ancient. I do not make another’s suit my own. But I shall copy in his own words what the most illustrious Christoph Besoldus, primary professor of the Academy of Würzburg, thinks in his juridical-political dissertation On the Law of Academies, chapter 3, page 200: “Immediately after theologians, or in second place, jurisconsults take precedence over physicians. Whether this happens by right is an ancient question. See Lipsius, Oration 8; Rodericus a Castro, The Political Physician, Book 1, chapter 12; Alphonsus Moditius, § Prudentum, question 12; Limnaeus, Disputation on Academies 2, thesis 10; the most illustrious Hilligerus on Doneau, Book 3 of the Commentaries, chapter 9, letter N; Johannes Gerardi, Century of Political Questions, decade 9, question 6; Johannes Baptista de Plotis and Count Rogerius, Matrimonial Counsels, tome 1, counsel 87 and following; Benius, On the Privileges of Jurisconsults, Book 3, chapter 55; Jacobus Martini, century 9 of Various Questions, disputation 2, question 10.
“I would not wish anything to be detracted from either art. But if it is fitting to pronounce an opinion from the feeling of one’s mind and judge from true foundations rather than begged votes, I would determine the matter by this distinction, with the most excellent physician Francisco Valesio in his Sacred Philosophy, chapter 74: that medicine must altogether yield to true jurisprudence, which is engaged not in pleading causes but in administering the state; but not to that petty practice which merely arranges lawsuits—or rather mixes them into entanglements.” This says that man who takes precedence among the jurisconsults.
§ 4. It is advantageous to a free state to summon physicians into the Senate. Kings and princes, however, provide most prudently for their own safety if they employ them in public counsels, provided that they are good and prudent men. For by that honor they bind their fidelity to themselves, and by trusting them they make them faithful to themselves. Next, since physicians know nature and natural affections, they can frequently persuade things which are advantageous, or certainly judge from countenances and eyes what things may be considered to be in the prince’s interest. The example in Antiochus, son of Seleucus, was pitiable, yet it was an example of medical sagacity. For Erasistratus detected the love of Antiochus, just as Hippocrates marked the madness of Perdiccas. Plutarch, Demetrius; Soranus, Life of Hippocrates.
Nor is it marvelous that great honors and dignities in the state are decreed to physicians. For formerly this was the care of kings. Solomon certainly, while enumerating the gifts of his wisdom in Wisdom 7:15 and following, acknowledges medicine: “But God gave me to speak according to judgment and to conceive things worthy of those which are given to me, since He Himself is the guide of wisdom and the corrector of the wise. For in His hand are both we and our discourses, and all wisdom, and the learning of the knowledge of works. For He gave me true knowledge of the things which are: that I might know the ordering of the world and the powers of the elements; the beginning, completion, and midpoint of times; the alternation, changes, and transformations of seasons; the courses of the year and dispositions of the stars; the natures of animals and rages of beasts; the force of winds and thoughts of men; the differences of shrubs and powers of roots. And I learned whatever things are hidden and unforeseen, for wisdom, the artificer of all things, taught me.”
Knowledge of these things is necessary to the physician; and when he has acquired it, he easily maintains the method of healing. Therefore men learnedly and fittingly called medicine the sister of philosophy. For the state will admit no one who is not well practiced in philosophy into the innermost things of medicine—that is, to preserve or destroy the lives of men. Dionysius the tyrant at Syracuse acted not only as a physician but also practiced surgery, as Aelian is the authority in Book 1. It is established that Mithridates, king of Pontus; Hermes of the Egyptians; and Ganges, king of the Medes, were most skilled in medicine and preserved the lives of many by their counsel. The emperor Pogonatus also embraced that art. When many magnates are occupied with the labors of waters, oil, and sublimations, and adhere to their alembics, what else do they do than prepare medicines?
It is no less unbecoming that kings should be physicians than philosophers; for medicine is not only a most honorable but also a most useful part of philosophy. Formerly physicians were indeed called physicists because they not only knew the natures and changes of animals, plants, and elements, the constitution of man, the causes of diseases, and the method of health, but used their knowledge for the health of each individual. Among cultivated peoples physicians were once held in such esteem that they built shrines and erected altars to Apollo, Aesculapius, Chiron, Machaon, and even Hippocrates, and assigned them divine honors. Indeed, the fables appointed Paeon physician of the gods, because that uncultivated age—which attributed anger, childbirth, wounds, and pus to the wretched stars—judged that not even the gods could lack so divine a knowledge and its use. Nor did they relate that Apis of the Egyptians was worshiped so religiously for any cause as much as because he was held to be the inventor of medicine. Celtic Hercules also, who because of his skill in healing was called Alexipharmacus, attained authority and resources no more through strength or bodily mass than by healing diseases.
Nor did physicians themselves despise their knowledge. Philo called the most efficacious medicines either πολύχρυσα (worth much gold) or πάγχρηστα θεῶν χεῖρας (all-useful hands of the gods). For four hundred years there were no physicians at Rome, as among a most turbulent and rustic people. At Athens they lived both few in number and without honor—
But this is not marvelous, for κακοβουλία (bad counsel) was peculiar to the Athenians, and indeed was so well known that their prophet Aristophanes casts it up against them as a familiar fact:
Φασὶ γὰρ δυσβουλίαν τῇδε πόλει προσείναι.
“They say that rash and evil counsels are conducted in the city.” What wonder, therefore, if they esteemed physicians little, when through their envy the best citizens were cast into exile?
§ 5. Finally, since very ready shortcuts to great riches are open to learned and faithful physicians, and since it is useful to the state that wealthy men should be in magistracies—both lest the dignity itself, having fallen into base men, be despised, and lest physicians, not bearing contempt for themselves, migrate elsewhere and abandon the state—the rulers ought to bind them to themselves by honor. Concerning the immense riches of physicians, others write, and especially our Laelius in Book 16, chapter 11, of Leisure Hours.
Erasistratus, who flourished about the year 600 of the city, after curing King Antiochus, as Pliny writes in Book 29, chapter 2, was given one hundred talents by King Ptolemy, his son—that is, sixty thousand of our gold pieces, as Budaeus calculates in Book 2 of The As. In the same place Pliny also numbers the Cassii, Carpitani, Arruntii, Albutii, and Rubrii, who received from princes an annual fee of 250,000 sesterces—that is, six thousand two hundred fifty gold pieces. Quintus Stertinius, however, charged the princes with the fact that he was content with five hundred thousand sesterces annually; for he showed that his gain from the city was six hundred thousand, the houses being named. That is, he obtained from citizens a sum greater by another such amount—fifteen thousand gold pieces—while the emperors themselves paid twelve thousand five hundred gold pieces.
Pliny adds: “An equal fee was poured upon his brother by Claudius Caesar; and although their property had been exhausted by works with which Naples was adorned, he left three hundred hundred-thousands of sesterces to his heir, as much as Arruntius alone had left up to that age”—that is, thirty million sesterces. “Recently,” says Pliny a little afterward, “Crinas of Massilia left ten million sesterces for the walls of his fatherland, when another man had also constructed fortifications for almost no smaller sum.” For it must be read thus, not “one hundred sesterces”; for how could so small a sum have sufficed for walls? Charnus likewise, from the same Massilia, contracted to cure a sick man from among his fellow Massilians or provincials for two hundred thousand sesterces—that is, five thousand of our gold pieces.
Why should I commemorate the resources of Archontius? Claudius confiscated from this man alone—he was a physician of wounds—when condemned, ten million sesterces, that is, two hundred fifty thousand gold pieces; yet within a few years no less was acquired by the same man in exile and when he had returned to Rome. The very ancient Democedes, as reported by Herodotus, Book 3, was hired for each year by the Aeginetans for one talent, by the Athenians for one hundred minas, and by the tyrant Polycrates for two talents. Thus it is in no way marvelous that Asclepiades, a master of rhetoric in the age of Pompey the Great, when he did not make good gain from that faculty, suddenly turned himself to medicine so that he might become wealthy. Pliny mentions him in Book 7, chapter 37, as the founder of a new sect, and in Book 26, chapter 3, and Book 29, chapter 1.
Conversely, a certain Gallus, a physician who was indeed most acute but most greedy for money, when he saw that he made little gain from medicine at Nicopolis, turned himself to pleading cases, as Antonius Panormita is the authority in Book 4, On the Deeds of King Alfonso. He turned the forum upside down with sophisms and cavils, but with a different outcome, since it was decreed by an edict of King Alfonso that a suit which had Gallus as patron should by that very fact be judged unjust.
We know that Galen was very wealthy. He himself testifies in Book 9, chapter 9, On Recognizing the Diseases of the Mind, that he was accustomed to spend a tenth part of his revenues annually and add the rest; thus he surpassed all his fellow citizens in riches, although he confesses that he was wealthy from his patrimony.
I come to the Christians. Thaddaeus of Florence, whose books concerning medicine are also read, when he departed from his fatherland for the sake of some treatment, hired out his work for no fewer than fifty gold pieces each day; and after curing Honorius, the Supreme Pontiff, he carried away ten thousand gold pieces. The same is related concerning Pietro d’Abano, who acquired the name of Conciliator.
Dubravius, Book 23 of Bohemian Affairs; Antonius Bonfinius, Book 2 of decade 3; and Aeneas Silvius, chapters 35 and 42 of his Bohemia, relate that a certain physician named Albicus, through the very ample riches which he had acquired by his art, made for himself with Wenceslaus, king and most indolent emperor, a step to the prefecture of the Church of Prague. You will read similar examples in The Theatre of Human Life, volume 10, Book 6, under the title Avarice ἐν λήψει (in receiving).
There is a saying of King Philip to a wealthy but avaricious and importunate physician. For when Philip had received a wound in the neck near the clavicle and was being treated by him, speaking as though whispering to the man in a low voice, he said, “Take as much as you please, because you have the key”—that is, λάμβανε ὅσα βούλει, τὴν γὰρ κλεῖν ἔχεις—as Plutarch reports in the Apophthegms.
With the best right, a physician will receive a gratuity for his labor, because it is advantageous that he be wealthy so that he may treat the poor without payment—or even treat everyone. Hippocrates certainly did so, and so did the parent of Ausonius:
“I offered aid,” he says, “to all who sought the service of an art not purchased, and my office was joined with piety.”
§ 6. Let no one be admitted to teach or practice medicine unless he has been taught for a long time and accurately. I spoke above concerning academic honors. Because they are often given to unworthy men, the prince ought not to rest upon that authority so that, if anyone comes from Italy or Gaul furnished with the testimony of some academy, he should thereby be judged a physician. For what is more unworthy than that a man who purchased the title of physician for a few gold pieces should possess a public right of killing and of seeking experiments of his art through deaths of obscure men and sometimes even of illustrious men? Too often the common proverb, derived from what was once done and said, is customarily bandied about:
Μόνῳ δ᾽ ἰατρῷ τοῦτο καὶ συνηγόρῳ ἔξεστιν ἀποκτείνειν μὲν, ἀποθνῄσκειν δὲ μή.
“To the physician alone and the advocate alone is it permitted to kill without the penalty of death.”
§ 7. Let it be a capital crime for an unskilled physician if he has undertaken to treat the sick, even if by chance he has cured them. For a good outcome is from God; his own rashness had destroyed the sick man. Certain laws reject such men and prohibit their practice, Book 6, § Sed et reprobari. And deservedly; for it is better that practice should cease than that men should be killed by drugs. But those who learn through our dangers, who conduct experiments through deaths, deserve a greater penalty. Pliny already complained long ago, in Book 29, chapter 1, that there was no law which punished the capital ignorance of physicians. To have given a deadly love potion was formerly a capital crime, because to have offered a doubtful medicine renders a man guilty of killing. But an unskilled physician cannot be certain. Thus he always hesitates in uncertainty whether he offers a salutary drug or a poison; and if it benefits, he does so by chance, not by knowledge. The woman who—
A jealous adulterous wife gave poisons to her husband, Nor believed that enough had been given for death; She mixed deadly weights of quicksilver—
is not free from crime; yet the husband’s life prevailed over the poisons fighting among themselves, and his survival does not thereby absolve the sorceress.
The law which I recommend is not severe. It concerns the life of men—
—and is on behalf of life. The man who treats a human life doubtfully has despised it. One who has led a city or army into danger is considered a traitor. What will you think concerning a man who, after receiving money, dispenses poisons and drugs with no certain discrimination? An unskilled advocate does less harm, because his error is more easily recognized and he has an opponent; therefore no one easily commits himself to the arena except with hope of victory. The affairs of physicians are secure: when they have killed, they are not accused; they deceive the sick. Thus there are few who plead cases while unskilled in law; but the error of physicians is recognized only when life has been despaired of, and it is frequently neglected by a greedy heir whom it benefited that the physician was unskilled.
I therefore think that, in a well-constituted state, this rashness must be restrained by a grave penalty, even a capital one. If this were done, not every village would abound with ignorant physicians. Otherwise there is no doubt that a physician of this kind binds himself by a crime. Navarrus, in chapter 25, concerning the sins of a physician and surgeon, says:
“It must be said, first, that a physician or surgeon sins when he practices without sufficient knowledge, even if he has been granted a laurel; and one who sufficiently knows the art but does not follow its precepts; and one who notably neglects to study or to visit the sick, although the sick man is cured—according to Saint Antoninus, with the obligation of restitution according to the opinion of Panormitanus and everyone; and one who applies medicines to a disease before he knows it. Nevertheless, one who through prolonged experience has learned to treat oblique maladies—for example scabies, a fracture of bones, a clouding of the eye, fistulas, and pain of the teeth, molars, ears, and other similar parts—can licitly treat them although he is ignorant of the rules of medicine, provided that he does it without any incantation or fascination, that when fever supervenes he employs a skilled physician for the sick man, and that he attempts nothing which he does not know.
“Second, one sins who, doubting whether some medicine was notably harmful or not, administered it so that he might experiment, make a profit, or not be regarded as ignorant, and so forth; and still more one who administers a thing which he knows to be notably harmful, even if he administers it from pity or in order to please the sick man; and one who abandons a sick man before he ought, from which death or prolongation of the disease results, with the obligation of restoring the loss; and one who, when some limb must necessarily be cut off, does not seek a man whom he believes will cut it off well, or who, doubting the necessity of amputation, ordered it to be cut off; and one who, not knowing how to let blood or cut off a limb, does either or both; and one who, knowing that an apothecary will use corrupted medicines, does not choose uncorrupted ones; and one who, in order that he may receive a greater fee, delays the treatment of a disease.”
The opinion of others is the same, and the counsel of Sylvester must altogether be maintained. “First, therefore,” says he, “it is asked what is required in a physician so that he can practice the art without sin. And I say that many things are required. First, it is required that he be so skilled that he is commonly considered suitable by men skilled in that faculty. It is not sufficient to possess a doctorate; otherwise, if from notable ignorance he harms the sick man in his treatment, he sins mortally, acting against the commandment ‘You shall not kill,’ De poenitentia, distinction 1, Homicidium. And according to Richard, he is held to make equivalent satisfaction to the sick man, since he cannot repair the principal thing. Indeed, even if health follows, he sins mortally, because he exposed himself to the danger of mortal sin—that is, to a work from which notable injury to his neighbor can follow. Nor is it an objection that he does not intend this, because he voluntarily places himself in a situation from which this is naturally able to follow: Article 15, question 1, Merito, and § Sed obicitur, concerning Lamech.
“Nor is he held only in the forum of the soul when he voluntarily harms—for example by prolonging illness and matters of that kind—but also when he harms from ignorance or inexperience or by not following the traditions of the art, as Petrus notes in Authentica Sed hodie, Code De iudiciis; because a physician’s inexperience is numbered as fault, law Si quis fundum, § Celsus, Digest Locati, and law Imperitia, Digest De regulis iuris. Panormitanus, however, in chapter Ad aures, De aetate et qualitate, limits this to when he voluntarily assumed the office; it is otherwise if from necessity and in good faith he did what he could when other physicians were lacking. Therefore let the man who chooses such a person impute it to himself, since that person said that he was unskilled.
“Second, he ought to be diligent. Therefore one who, after having been requested, is notably negligent in reviewing books, visiting the sick man, examining the quality of medicinal things, and similar matters, if death follows, is irregular and sins mortally; and similarly if a great aggravation of the illness follows without death. But according to Antonius de Butrio, in chapter Tua nos, De homicidio, he is said to have employed all the diligence which he ought when he follows the traditions of the art, visits personally, and dictates a regimen to the sick man. He is not held to continuous personal watch, according to Hostiensis; and thus the outcome of death is not imputed to him: Digest De officio praesidis, law Illicitas, § Sicuti.
“Third, he ought to possess a justified intention, so that he does not intend to profit from another’s loss: De regulis iuris, Nemo, Book 6. Therefore he ought to conclude the treatment as quickly as he can. If he extends and prolongs the treatment for profit, he sins mortally and is held to restore the excess. Likewise, if he permits the apothecary to place in the composition of a medicine ingredients which are insufficient through age or some other defect so that he himself may profit more, he sins gravely, and each is held to the sick man for every loss. Indeed, according to the Archdeacon, he ought not to trust an apothecary unless he knows that he is conscientious, skilled, and practiced; rather, the composition of the medicine ought to take place beneath his own eyes. Nevertheless, if he gave the medicine according to the art and displayed all due diligence, it is not imputed to him if through a defect in the ingredients or some other admixture it is harmful: De clerico excommunicato ministrante, chapter Apostolicae, according to Innocent and Hostiensis. In all the aforesaid cases, however, he is held according to the judgment of good men.”
And again: “How ought a physician to conduct himself in applying medicines or remedies to bodies? I say many things. First, according to Innocent in chapter Tuo nos, De homicidio, he ought diligently to take care that he does not apply medicines concerning which he is not certain according to the art; because if he doubts whether they ought to benefit or harm, he sins by giving them. For in doubtful matters the safer road is to be followed: this is to leave the sick man to nature and the Creator rather than expose him to a medicine which he does not know.”
Since, therefore, jurisconsults and theologians arraign unskilled physicians as guilty of killing, the vigor of the laws ought to be armed against them no less than against brigands, since they destroy more men; and magistrates who neglect their office in this part involve themselves in another’s sin.
§ 8. Physicians, therefore, must be examined most diligently and severely before they are presented for the care of a state. Nor is an injury inflicted upon the academies which promoted a Doctor, for a great part are proclaimed Doctors before practice. But a prudent prince will admit no one unless he has already practiced under another master, lest he conduct experiments through deaths. Moreover, they must be examined in every part of medicine. Some establish three parts of medicine: dogmas, method, and experience. In academic promotions, dogmas, enunciations, and aphorisms are sought; their rationale, or method, is exacted; experience is not yet present. Yet this too must be known.
Plato divides medicine into that which assists a sick man with medicated plants, potions, and pastilles; then into surgery, to which belong emollient poultices, plasters, incisions, and cauterizations; third, into the care of daily diet and exercises—
fourth, into that which quickly recognizes diseases and at last treats them; finally, into that which comes to aid with great and swift assistance, as though by a divine hand, and drives away pains. But these methods are generally so connected with one another that, with surgery almost alone excepted, they cannot be separated.
Our men divide it into that part which treats the constitution of man and embraces anatomy and complexion, or temperament; then into that whose office is to preserve bodies from diseases. Since very few men employ this part and are accustomed to consult a physician only when the violence of disease cuts off the hope of life, so many cohorts of diseases therefore rush upon them—as though God sent the heavenly gift of medicine to us from those ethereal seats only so that we might drive out a plague which has slipped into our entrails, and not also so that we might turn it away as it comes.
The third part investigates the causes of diseases and, in diseases, the causes of symptoms; complete knowledge of the first part is necessary to it. Joined to this is the part which teaches concerning signs and critical indications, judges future crises, and knows which things are present and which have passed. An experienced physician does this so dexterously that Hippocrates asserts medicine to be akin to prophecy. Hence ignorant antiquity also attributed foreknowledge of future things to Apollo. The fifth part maintains the method of healing, whether it be by diet, by medicines taken in any manner, injected into the viscera, or poured on, or by a different kind of surgery. This extends most widely. For it is necessary that the physician know every kind of medicine, simple and compound, and take care that they are prepared with great care.
In all these matters he will have to be tested long and much before he is approved. Nor must the learning of the novice Doctor be explored only by disputation; he will also be compelled to mix and compound the pills themselves and to approve and disapprove the drugs of apothecaries. Sylvester certainly shows this when he denies that an apothecary is to be trusted unless the physician knows him to be conscientious, skilled, and practiced; rather, the composition of the medicine ought to take place beneath his own eyes. The physician will inspect it in vain if he is ignorant of practice. Therefore this part also must be cultivated. For if he knows it and then learns the prescriptions of noble physicians, he will easily treat common and familiar diseases; but if he is ignorant of the substances to be compounded, as they call them, those precepts will help nothing. He will insert a melon in place of a radish and wrench the soul from a wretched man by a medical death.
§ 9. Let none even of the most approved physicians employ a new medicine unless it has also been approved by others. I am not unaware that many things can be added to the discoveries of the ancients, nor do I condemn new things in the arts. For if all sciences have received great increases through an interval of time, I do not see why this should be denied to this one alone. Yet because experiments upon the human body are dangerous, he will also hear the opinions of others. The law of the Egyptians, concerning which Diodorus Siculus writes in Book 1, chapter 6, did not seem unjust to me: it freed from blame a man who did not heal the sick after administering medicine according to the precepts of the sacred book, but punished with death one who instituted a treatment contrary to those doctrines.
Nor should those be heard who allege that they are unwilling to disclose great secrets and efficacious remedies. Through that boasting of secrets they build up in advance authority for their idleness and ignorance—indeed, often for imposture. If the remedies are good and possess a rationale, it is better that they be made known than lie hidden. They propose poisons dangerously compounded, distilled waters, and violent remedies; and while they treat one disease or part, they consume the whole body.
§ 10. So that medicine may be rightly administered, the prince will establish academic professors with great stipends and gratuities. Then he will liberally support, for six or seven years in that study, three or four men born of distinguished ancestry, of good morals, and endowed with great abilities. So that lawful physicians may possess honor and recompense, however, he will forbid there to be a multitude of physicians—a multitude, I say, of physicians. It is now so great that there is no village so abject in which several are not found; for where no one is a physician, everyone professes medicine.
I laughed when, in a noble city of Germany, I learned that there was no Doctor of medicine and asked whom, therefore, the sick consulted. The answer was that, besides prophetic old women, a pharmacist, surgeon, apothecary, confectioner, bath attendant, Jew, and even executioner compounded doses, observed signs, and discharged every office of a physician. “And all,” they said, “grow rich by this art.” I did not conceal my opinion, but said that the magistracy sinned gravely: not only because it called the health of the citizens into danger and made simple persons the prey of cunning men, but also because by this method it furnished an occasion for superstitions and magical deceptions.
The desire of living is great and natural in everyone and excessive in most. A sick man is deceived by nothing more easily than the hope of health. Thus they descend to every measure and, if they cannot bend those above, they move Acheron. Pliny, in Book 30, confesses concerning magic truly and according to the opinion of all the Doctors: “No one doubts that it was first born from medicine and crept in under a salutary appearance as something higher and holier than medicine. Thus to the most flattering and most desired promises it added the powers of religion, before which the human race is still especially benighted.” And certainly, through the hope of medicine, the devil enticed many living men into this abyss. If, therefore, the magistracy desires to furnish a state pure from magic, let it forbid those clandestine physicians—or rather diviners—to exist. Let it enjoin silence upon them through fear of death.
I do not doubt that the custom of the Babylonians was foolish. They placed the sick in public so that, if anyone had at some time been healed of the same disease, he might transmit the method of healing to the sick man; nor was anyone permitted to pass by without learning about his disease. It was a foolish practice, I say, for the sick man was both afflicted publicly and made to struggle with so many counsels, and—what was gravest—he often had to trust an unknown and ignorant man. But such great ignorance existed publicly that they thought the same diseases in different men and at different ages were to be treated by the same remedies.
We therefore laugh at those things, but we see worse things committed by those who entrust the life and health of the body to unlearned men. For those men maintain some medical method by which they know that certain persons were at some time assisted; they apply it to everyone as a πανάκειαν (panacea), than which nothing is more destructive. They also often place souls in danger while they expect health through incantations from witches—that is, from the demon.
We marvel that the credulity of the ancients advanced so far that they believed still greater things. Democritus promised a composition of a medicine by which beautiful and fortunate children would be born, but we see such things every day. Asclepiades, the freedman of Pompey the Great, once innovated in medicine, and Pliny relates that “he turned almost the entire human race toward himself in no other manner than if he had arrived after being sent from heaven.” Furthermore, he drew minds by a marvelous artifice, promising wine to the sick and giving it at the proper time—
and then cold water. Since Herophilus had first instituted the search for the causes of diseases and Cleophantus had made illustrious among the ancients the rationale of wine, Asclepiades himself preferred to acquire a name by giving cold water, as Marcus Varro is the authority. He also devised other flatteries: now suspending little beds, by whose rocking he might either lessen diseases or elicit sleep; now instituting baths for the most eager desire of men; and many other things pleasant and agreeable to say. He acquired great authority and no less fame when, having encountered the funeral of an unknown man, he brought the man back from the pyre and preserved him—lest anyone suppose that so great a transformation was produced by light causes.
This alone we can regard with indignation: that one man, sprung from a most insignificant nation and without any resources, for the sake of his own revenue suddenly gave laws of health to the human race, which many afterward nevertheless abrogated. Many things assisted Asclepiades: the excessively anxious and crude care of those men, such as burying the sick beneath clothing and inducing sweats by every means; now roasting bodies beside fires or continually seeking the sun in a shady city; indeed, when all Italy was mistress of the world, then first flattering desire without limit by the use of suspended baths. Furthermore, in certain diseases he removed the tortures of treatment, as in anginas, which they treated by an instrument lowered into the throat. He deservedly condemned vomitings, then excessively frequent. He also accused medicinal potions as hostile to the stomach, which for the most part has been forbidden. Therefore we mark above all the things which are useful to the stomach.
These things possess some rationale. But that which Pliny adds in Book 26, chapter 4, is detestable: “Above everything, magical vanities assisted him, raised to such a height that they could abolish confidence in all herbs.”
§ 11. Let the care of an excellent physician be that, when it can be done, the sick employ simple and obtainable medicines. Pliny speaks truly in Book 22, chapter 14: “That parent and divine artificer of things did not make wax salves, emollient poultices, plasters, eye salves, and antidotes. These are inventions of workshops—indeed, more truly of avarice. The works of nature are born complete and perfect, with a few things assumed by reason, not conjecture: so that dry substances may be tempered with some juice for the passages, or moist substances with another body for cohesion. To collect and mix powers by scruples is not a work of human conjecture but of impudence.”
Hence it has been brought about that a pharmacy is not permitted to physicians, lest they devote themselves to selling wares rather than to health. But because there can be a conspiracy between the apothecary and physician, the state will do excellently if it itself undertakes that care. Yet I do not see this done, although it would be most praiseworthy, while in many places princes and cities assume for themselves as though a royal care the selling of wine, the grinding of grain, and other matters.
Pliny praises the diligence of the ancients in Book 23, chapter 6: “One cannot sufficiently marvel at the care and diligence of the ancients, who, having searched everything, left nothing unattempted. In this very pomegranate there are little flowers which burst forth before the fruit itself appears, which we have said are called balaustium. Therefore, having tested this too, they discovered that it opposes scorpions.”
But he says that that diligence was corrupted and removed and complains, in Book 24, chapter 1, that frauds succeeded in its place: “Hence medicine was born. These alone had pleased nature as remedies prepared for the common people, easy to discover and without expense, from which we live. Afterward the frauds of men and snares of abilities invented those workshops in which his life is promised for sale to each man. At once compositions and inexplicable mixtures are loudly proclaimed. Arabia and India are valued in their midst, and a medicine from the Red Sea is charged to a little ulcer, although the poorest man eats the true remedies every day.”
The physician who heals without expense will not thus be less esteemed, but more readily available and more honored; for great care also exists in applying medicines liable to danger. Herophilus, the noble physician, said excellently that many herbs benefit when trodden underfoot.
§ 12. Let the state also possess men who gather medicinal plants at the proper time, for Pliny is the authority in Book 24, chapter 2, that the whole of medicine was once in these: “This was ancient medicine, which migrated entirely into the Greek language. But the reason why more plants are not known is that country people and those ignorant of letters test them, since they alone live among them; furthermore, the ready availability of a crowd of physicians gives security from searching. Names are also lacking for many discoveries, as for that plant which we reported in the care of grain and which we know, when buried at the corners of a field, causes no bird to enter. A most shameful cause of their rarity is that even those who know are unwilling to show them, as though what they transmitted to others would perish from themselves. Added to this is the uncertain method of discovery. Indeed, even among things discovered, chance finds some and—as I shall speak truly—God finds others.”
And these things were once valued so greatly that it was sufficient for the Arcadians to employ as medicine the milk of cattle which grazed in places rich in plants. Pliny, Book 25, chapter 8: “Otherwise they relate that Mount Pelion in Thessaly, Mount Telethrius in Euboea, and all Arcadia and Laconia are rich in plants. The Arcadians indeed employ not medicines but milk around springtime, since then plants swell especially with juices and udders are medicated by the pastures. They drink cow’s milk, since cattle are almost omnivorous among plants. The power of plants through quadrupeds is still made manifest by two illustrious examples.”
But this practice is Arcadian and belongs to ancient foolishness; for since the kinds of diseases are varied, that γαλακτοποσία (drinking of milk) cannot remedy everyone, but only some.
§ 13. The prince ought to take great care that new medicines are not introduced, as I have said; for the trial is attended by uncertainty. Those whom they call Paracelsists must therefore be admitted cautiously. Pliny proves that no art has been more inconstant, and that it was changed rather frequently even in his own time. The cause of the change is desire for gain, so that they may attract men to themselves by novelty. New things, however, are eagerly taken up by the sick, because they perceive that they are being cured slowly by the old ones; and, just as they delight in changes of rooms and beds, so too they delight in variety of medicine.
Hippocrates long held sway over everyone; he became renowned around the beginning of the Peloponnesian War. They say that he drew his ability to heal from remedies written in a temple according to custom; for it was the custom that those who had been freed from diseases should deposit in the temple a written account of the kind and method of the remedy. Having used these, he is said to have gained fame after the shrine had already been burned. But so great a knowledge of things sufficiently shows that he employed another teacher. He indeed healed everyone without payment, but Prodicus, his disciple, made the art profitable and instituted iatroleptics. Chrysippus, however, altered their doctrines, and Erasistratus, the grandson of Aristotle, altered those of Chrysippus; and thus the disciples rejected their teachers.
In Sicily there was a sect of Empirics, with Acron of Acragas as its founder. Since it rested upon opinions and experience, it was quickly dispersed into various little sects, all of which Herophilus deservedly condemned. The words of Pliny, Book 29, chapter 1, concerning the sect of Herophilus should be noted: “Then this sect too was abandoned, because it was necessary to know letters in it.” I marvel and am almost stupefied that there were sects of physicians which did not know letters, and that the one which required a knowledge of letters—
was abandoned for that very reason. But even today, when illustrious physicians have been forsaken, do not many seek health from old women and country people, and embrace their sayings all the more because they come from the unlearned?
Asclepiades followed next. His hearer Themison altered his precepts; Antonius Musa altered Themison’s doctrines when he had cured Augustus by a contrary treatment. But Valens Vectius, Messalina’s adulterer and powerful for that reason, also founded another sect. Under Nero’s rule Thessalus abolished all the decrees of the ancients and declaimed with a certain madness against the physicians of every age. He caused it to be inscribed upon his tomb that he was Iatronicen, “the conqueror of physicians.” Meanwhile he drew the whole city after him; that age, Pliny says, “leapt over to him.” No actor’s or driver of a three-horse team of mares’ appearance in public was more fully attended. But, while he was still alive, his own crowd deserted him. For Crinas of Marseilles, having doubled the art in order to appear more cautious and more religious, surpassed him in authority by giving foods according to the motions of the stars from a mathematical ephemeris and by observing the hours. “These men ruled the fates,” says Pliny in Book 29, chapter 1, “when suddenly Charmis, from the same Marseilles, invaded the city. He condemned not only the earlier physicians but also the baths, and persuaded people to wash in cold water even amid the chills of winter. He plunged the sick into pools. We used to see aged men of consular rank stiff with cold even to the point of ostentation.” Concerning this there also survives the supporting testimony of Annaeus Seneca.
Nor is there any doubt that all those men, hunting for fame by some novelty, immediately trafficked in our lives. Hence those wretched contests of opinions around the sick, with no one judging the same thing lest he appear to be another’s appendage. Hence that inscription upon an unhappy monument: that he had perished through a crowd of physicians. “The art changes daily; so often are we altered, and we are driven by the breath of Greek talents. And it is manifest that, as each among them grows powerful in speaking, he is immediately made emperor of our life and death—as though thousands of nations did not live without physicians, yet not without medicine, just as the Roman people did beyond its six-hundredth year. Nor was that people itself slow in receiving the arts, and it was even eager for medicine, until, having tried it, it condemned it.”
You indulge your pen too much, O Pliny. It did not condemn the art, but the vices of men: avarice, cruelty, and pride. The art is to be retained, the vices restrained, and, so that they can be restrained, their occasions must be removed. This is clear from the fact that the Roman people held Archagathus exceedingly dear; but since he was a wound-physician, through cruelty in burning and cutting his name passed over into “executioner,” and the art into loathing. The very words of Cato show this:
“I shall speak about those Greeks in their proper place, my son Marcus: what I have discovered at Athens, and that it is good to inspect their literature but not to learn it thoroughly. I shall prove them a most wicked and unteachable race; and consider that a prophet has said this: whenever that nation gives us its literature, it will corrupt everything—even more so if it sends its physicians here. They have sworn among themselves to kill all barbarians by medicine. But they do this very thing for a fee, so that they may be trusted and may easily destroy us. They also repeatedly call us barbarians, and foul us more shamefully than others by the name of Opicans. I have forbidden you to have dealings with physicians.”
And this Cato died in the 605th year of our city and the seventy-fifth year of his own life, lest anyone suppose that he lacked either public times or the private span of a life for making trial. What, then? Do we believe that a most useful thing was condemned by him? By no means, by Hercules; for he adds by what medicine he brought both himself and his wife to a long old age—namely, those very things which we now treat. He also declares that he possesses a notebook by which he may treat his son, his slaves, and the members of his household, which we set forth according to the kinds of its use. The ancients did not condemn the thing, but the art. Above all, however, they refused to let gain be made from life at a monstrous price.
§ 14. Let a sworn apothecary preserve all compositions and prescriptions of drugs; and every year let other physicians, with leading men from the senate joined to them, institute an examination not only of the apothecaries’ shops but also of the medicines dispensed. For if an error has been committed, if a medicine was suited neither to the age nor to the person, many things will be able to be corrected; and if the matter rested upon injury to another’s life, the physician can be warned not to sin further, and, if the error was more serious, can be removed. For since the people cannot judge, the prince ought to entrust that care to skilled men. In this matter nothing is more wretched than man, and so it was formerly as well. Pliny, Book 29, chapter 1:
“Roman gravity does not yet practice this one alone of the Greek arts, despite so great a benefit. Very few of the Quirites have touched it, and they themselves immediately became deserters to the Greeks. Indeed, authority does not belong to those who treat it otherwise than in Greek, even among the unlearned and those unacquainted with the language. And they trust less what pertains to their health if they understand it. And so, by Hercules, in this art alone has it happened that anyone professing himself a physician is immediately trusted, although in no falsehood is the danger greater. Yet we do not look at this, so beguiling for each person is the sweetness of hope on his own behalf.
“Moreover, there is no law which punishes deadly ignorance, no example of vengeance. They learn through our perils and conduct experiments through deaths; and for a physician alone, to have killed a man is the highest impunity. Indeed, abuse is passed onward, and intemperance is blamed, and those who have perished are accused besides. Yet panels of judges are, according to custom, examined by the censures of princes; an inquiry is conducted through walls; and one who is to judge concerning a coin is summoned from Gades and the Pillars of Hercules, while in a matter of exile a ballot is given only to forty-five selected men. But what kind of men enter into consultation concerning the judge himself, immediately about to kill him? Deservedly so, while none of us pleases to know what is needed for his own health. We walk with another’s feet; we recognize with another’s eyes; we greet by another’s memory; we live by another’s labor. The values of nature and the proofs of life have perished. We have nothing else as our own except pleasure.”
Certainly, in civil cases an appeal is granted, and after the appeal a review, so that a good cause cannot perish through the law. Here, where human life may be lost, let an inspection be established, so that there may be some fear of killing.
§ 15. A physician who is to be admitted to practice in the state shall furnish an oath that he will be not only faithful, but will also, as much as he can, moderate expenses according to the circumstances of the persons. Let the inspectors also consider whether, in an ordinary disease curable by cheaper remedies, he has caused heavier expenses without reason. For why must pearls and gems be dissolved—a thing prodigious even amid royal luxury—if beet and mallow evacuate the bowels more beneficially? Things readily at hand are more harmless. For if God had willed that costly things alone should benefit, he would have provided only for the few rich men. I call things costly not only in kind, but also in mixture. Good God, how often have I heard that many things—seventy-four ingredients, if I am not mistaken—enter into a single most costly little powder. How are the powers of all of them tempered with one another? Pliny complained of these things long ago:
“A composition devised by luxury is called theriac. It is made from foreign things, although nature has given so many remedies which would suffice individually. The Mithridatic antidote is compounded from fifty-four things, with no two of equal weight, and for certain things the sixtieth part of a single denarius is prescribed. Which of the gods, by Faith, revealed these things? For human subtlety could not have been so great. A display of art and a portentous advertisement of knowledge—
is manifest. And not even they themselves know it. I have discovered that red lead is commonly added to medicines in place of Indian cinnabar through ignorance of the name; we shall teach among the pigments that it is a poison.” Behold: through the physician’s ignorance poisons are given for medicines.
§ 16. But we deal with private persons in vain unless a public law comes to their aid. For just as there is a certain luxury of life, so there is also ostentation in medicine. A philosopher says nothing so absurd that it is not believed through someone’s levity; a physician prescribes nothing so poisonous or vain that it is not taken even with danger. They have handed down medicines made from the ash and nest of the phoenix.
§ 17. When a disease is dangerous, let the physician warn the sick man concerning the salvation of his soul. The counsel of Navarrus and others in this matter is moderate, under the word “Physician”:
“Thirdly, he sins who does not persuade a sick man to make confession before he applies medicine to him. This has no place when it is manifest that the disease is not dangerous, whatever Sylvester may say; nor even when he believes it to be dangerous and lethal, if, according to the custom of good and honorable physicians, he warns the man’s parish priest, or those who have the care of him, that they should provide the sacraments to him, and physicians themselves omit to say this personally—not because they are unwilling to do it, but because they think, according to Cajetan, that it would harm the sick man. For, as he himself and we say, that constitution has been received and is observed in this manner; and although the sick man is unwilling to confess, he is not on that account to be abandoned by the physician, according to everyone.”
§ 18. If any physician proposes shameful remedies for health, such as the warm blood of a slain infant, as was done for Constantine, drunkenness, γονόῤῥοιαν (seminal discharge), adulteries, or abortions, let him be intestabilis—legally disqualified—and let him be punished in proportion to his fault. For life ought not to be preserved through crimes. Therefore care must be taken that he be a good man, lest, while he treats diseases, he introduce greater evils of morals. Accordingly, let him believe that health is a gift of God, let him depend upon God, and let him not attribute this to himself, so as to assert that he can heal the sick when God does not approve.
Pliny testifies that morals have been corrupted under the appearance of medicine: “Those things destroyed the morals of the empire, those things which we endure while healthy: wrestling practices and wax salves, as though instituted for the sake of health; burning baths, by which they persuaded men that food was cooked within their bodies, so that no one came out without being weaker, while the most obedient were carried out for burial; then the drinking of those who were fasting, and vomitings, and again deep drinkings; and the emasculating removal of hair by means of their resins; and likewise the pubic regions of women actually exposed in public. Thus it is assuredly: a plague of morals, and none greater than from medicine, daily makes Cato altogether a prophet and his saying an oracle—that it is enough to inspect the talents of the Greeks, not to learn them thoroughly.”
These things should have been said on behalf of that senate and the six hundred years of the Roman people against an art in which, under a most treacherous condition, the good create authority for the worst; and at the same time against the stupefied beliefs of certain men who think that nothing benefits unless it is costly.
I pass over Apollonides of Cos, who deservedly, after a year’s αἰκισμὸς (maltreatment) and torture in the Persian manner, was buried alive, and others as well, because I treat of physicians, not of the vices of men, which are found monstrous in every class of men.
§ 19. The things said against physicians pertain to itinerant practitioners and impostors. There is scarcely any physician in Muscovy; the duke alone has one. Yet treatments are not lacking there, whether derived from experience or from superstition. The world has always wished to employ such things and has learned them by its own loss. See the Questions of Rodericus a Castro. At Rome medicine at first lay prostrate; afterward it ruled. Nor is that surprising in a rustic people which for many centuries lacked even bakers, when a dictator used to cook turnips for himself.
Many teach from Genesis 50:2 that physicians were slaves in Egypt; for Joseph commanded his servants, the physicians. But the proof is weak. For by that reasoning Joseph’s brothers also would have been of servile condition: according to the custom of the East, magnates called themselves the servants of kings, not after the manner of chattels, but to declare their readiness for obedience. Nevertheless, nothing prevents the most wise Joseph from having willed that certain chattels be taught medicine.
Solomon was the prince of physicians: he embraced the whole of natural philosophy and discussed most wisely whatever was ever known. Even now diviners, enchanters, empirics, Hermetics, and observers of the stars and constellations bring medicine into disrepute, as do the inventors of weapon-salve, or the diabolical advocates of magnetic cures. Concerning them, see the most learned man Johannes Roberti against Goclenius, and the disputations of Gaspar Wenck published at Dillingen; and the work of the same Roberti against the Synarthrosis.
These things concerning education. What can be said concerning jurisprudence and likewise theology is more properly set forth in the book concerning laws and the ecclesiastical magistracy. Education for military service and war itself must be treated in a separate book. I shall conveniently speak concerning the mechanical arts when I give an account of acquiring power; for although they can have another end, they nevertheless almost always have χρηματοποιίαν (money-making) set before them. Nor must I treat of them in any other way than that they be adapted to the state. For all things have their true use if they are conducted for the public good.