Circulating Now welcomes guest blogger Richard Tait, PhD, who shares his research on a rare incunable in the National Library of Medicine’s collection. Dr. Tait is currently at the Centre for Medieval and Renaissance Studies, Monash University. His recent work centers on the professional practice of medical doctors in the sixteenth century in northern Italy.
One of the little-known treasures of the NLM collection is a small book written in Padua in the fifteenth century on the conduct of physicians. It was written by Gabriele Zerbi, a rich and eminent physician living in Padua. Zerbi was at this time Chair of Theoretical Medicine at the University of Padua, and had formerly been personal physician to both Popes Sixtus IV and Innocent VIII. Zerbi was a prolific author, writing books on metaphysics, anatomy, aging and the function of the kidney, copies of several of which are also in the NLM.
Zerbi’s book on conduct, written in 1495, is entitled “Precautions for Physicians” (De Cautelis Medicorum) and has a special interest for me. It is perhaps unique for the insights it provides into how a doctor should conduct himself, but also how a doctor could achieve fame in society. There is also a deep irony attached to the book—ten years after it was written, Zerbi and his son were brutally murdered by the family of a patient who died in his care. Zerbi had been richly rewarded when he relieved the symptoms of his patient—the Ottoman governor of Bosnia, but his patient relapsed and died, causing his family to accuse Zerbi of poisoning him. He was executed by being strapped between two planks and then sawn in half—after watching his young son suffer the same fate. The irony is that Zerbi’s book warned of the dangers to the doctor of treating terminal patients, and advised that the doctor beware of the patient’s family, and preferably be absent when a patient died!
Zerbi’s is exceptional amongst the other books on professional conduct from the early modern period, in the insights it provides to how physicians thought about their practice. All of them dealt with the desirable moral character of the doctor, the importance of assiduous learning, and the importance of the admonitions of the Hippocratic Oath and Law. Zerbi’s book goes further, however, into how the doctor must protect his reputation from the many pitfalls that await. His prologue explains that his book will help protect the doctor from the disappointments, shame and dishonor that threaten those who practice medicine. He warns of how to manage the expectations of the patient and their family, how to proceed if unsure of the prognosis, and how to handle sudden reverses in the patient’s conditions. The image of the doctor as a God-fearing but careful man was perhaps reflected in the image of the rabbit in the woodblock capital at the start of the main text.
Zerbi is cautious of malicious rivals, labeling them ravening wolves, and recommends behaviors to avoid embarrassment and slander by competitors and maintain “face”. The medical marketplace in Padua and Venice was very crowded, with many university-qualified doctors as well as charlatans selling proprietary cures, herbalists and religious healers amongst others. All were competing for their share, in particular for the attention of wealthy clientele.
Zerbi’s book reveals the sense of exposure and insecurity felt by even eminent physicians in the late fifteenth century. The aspiring doctor must work hard to develop his reputation, and then take great care to foster and protect it. Reputation was the foundation of social status, and practicing medicine with its many uncertainties, exposed that reputation to risk.
The book itself is very slim, only 16 folios and is directed at an audience of young doctors, perhaps Zerbi’s students at the university. He emphasizes the areas where the young physician should focus in order to be successful, including shaping his own character, honoring God, being virtuous and studying hard. A chapter on dealing with the patient provides detailed instructions on how to develop their trust, deliver a prognosis, and discussing fees. The final chapters deal with the doctor’s interactions with others involved in the cure—members of the patient’s household and apothecaries amongst others. The short final chapter deals with maintaining the doctor’s position in society and how to behave in public to maintain a proper professional dignity.
Zerbi’s small book was published in six editions from 1495-1528 and is known to have been used from Italy to modern day Spain, France, Slovakia and Austria. Along with a high number of surviving copies (fifty-five copies of all editions are known to still exist), we can say that Zerbi’s book was popular with contemporaries, if short of being considered a best-seller.
Venice and Padua were a highly competitive environment for doctors, with a large number of practitioners and many more medical graduates than could find employment locally. Zerbi’s book, presented as a guide to success, reveals how they thought about that was required to be successful. That involved more than just medical skill, they had to be diligent and work hard, but also manage their reputation in the community and avoid the many potential professional pitfalls that awaited the doctor.
This post is drawn from Dr. Tait’s broader project on the professional conduct of early modern doctors, for which he has been examining the influence that books like Zerbi’s had on contemporaries. You can read the abstract for his most recent article here. You can reach Richard Tait at: email@example.com