Medicine as practiced was even more diverse than medical theory, in terms of both the approaches of medical practitioners and the range of practitioners available, though all practitioners regarded their work as important for individuals and for society at large. The highest-status - and highest-paid - medical practitioners were university-trained physicians, whose course work remained largely theoretical and all in Latin until the eighteenth century, when a few daring professors began to lecture in the vernacular. Physicians were in charge of the internal body, so their advice was sought for illnesses that appeared to come from within, such as fevers.
After the fourteenth-century outbreaks of the plague and of other epidemic diseases, towns and cities, first in northern Italy and then elsewhere, appointed official city physicians or boards of medical commissioners. These individuals were charged with developing and enforcing measures that would limit the spread of disease - quarantining infected houses or streets, disposing of corpses and the belongings of the dead, prohibiting public gatherings, and setting out cordons sanitaires, “sanitary cordons” around uninfected areas. At first these commissions disbanded once the threat posed by an epidemic had passed, but by the sixteenth century northern Italian and German cities often made these positions permanent, and charged physicians with the routine supervision of public health. City physicians and commissions developed (and tried to enforce) sanitary regulations about the disposal of waste, supervised other medical practitioners, and investigated reports of new diseases. In the seventeenth century, some cities, territories, and states expanded the role of these boards - often called a collegium medicum - to include developing and offering a licensing examination for any physician who wanted to practice in the area. Officials in centralizing states slowly came to regard a large and healthy population as essential to the well-being of the state, and called for the keeping and study of better vital statistics, including birth, death, and morbidity rates, as a basis for health policies.
Hospitals were increasingly viewed as important institutions for maintaining public health. In the centuries before 1450, hospitals were primarily charitable institutions whose main function was caring for the spiritual and physical needs of the ill, infirm, mentally ill, or elderly poor; they gave such people beds, food, and a (relatively) clean place to die. Many cities also had leper - or pest-houses for those with contagious diseases; with the advent of syphilis in the 1490s, special “pox-houses” were set up in German
And Italian cities for those who were infected with this new disease. Medieval hospitals and pest-houses were often small privately endowed institutions that were inefficiently run. City governments, first in Italy and then elsewhere, gradually consolidated these into large general hospitals over which they exerted stricter oversight and control. Like the poor in general, residents in these hospitals were often divided into “worthy” and “unworthy.” Care for the latter group - which included vagrants and beggars who were sometimes rounded up off the streets against their will - involved enforced labor and strict moral discipline. Even the “deserving” poor, such as widows and orphans, might be expected to work as much as they could while in the hospital, however, for work was viewed as spiritually fulfilling, and thus as contributing to the healing process.
Treatment for illness was always a part of hospital care, and during the seventeenth century mercantalist ideas about the importance of a growing and productive population led to more attention to strictly medical issues within hospitals. Regular rounds in hospitals examining and treating patients gradually became a part of medical training, with physicians recording their clinical experiences in casebooks. Medical reformers emphasized the role that hospitals could play in research and the rehabilitation of workers and soldiers. In Britain, philanthropic “alliances against misery” began to open voluntary hospitals in the middle of the eighteenth century, describing their function as the maintenance of public health and vigor as well as the treatment of individual illness.
The impact of public health measures and improvements in hospitals was limited, however. London, Genoa, and other cities saw devastating outbreaks of the plague in the middle of the seventeenth century, with smaller outbreaks continuing in western Europe until the early eighteenth and in eastern Europe until the later eighteenth century. Even after the plague had disappeared - and the reasons for this are not entirely clear - infectious diseases such as cholera still killed huge numbers of people, especially in crowded cities. Not until the early twentieth century would anyone who was not poor generally enter a hospital, for they remained places most people exited feet first.
World History
