Historical background

Photo by George Dunea

The history of the Venetian republic begins with the plunder of Rome in 410 AD by the Visigoths and the destruction of Aquileia in 452 AD by the Huns precipitating a flight to safety to the largely uninhabited islands of the Venetian lagoon. The refugees formed a republic that lasted more than one thousand years until Napoleon put an end to it in 1797.¹

The refugees to the lagoon soon became organized. By 650 AD they had elected a doge. Two centuries later they adopted a constitution that served them well for some 800 years. Nominally under the sovereignty of the Eastern Byzantine Empire, they developed separately from the other Italian city states. They built ships, offered their services to others, and became masters of the Mediterranean. They grew rich through trade, brought spices and perfumes from the Orient, expanded into Dalmatia, Albania, the Peloponnese, Crete, and Cyprus, establishing coastal trading posts but never going much inland. They became even richer during the Fourth Crusade of 1204 by sacking the great city of Constantinople. When the Ottoman Turks came a century later and made life perilous in the Eastern Mediterranean, Venice turned its sights to the mainland, the terra firma, annexing the cities of Padua, Vicenza, Verona, and Brescia. Defeated in 1509 at Agnadello by a coalition of rival Italian states, it went into a slow decline but remained a center of culture and a model of efficient administration and flourishing bureaucracy.¹

 

The University of Padua

After its conquest of Padua in 1404, Venice adopted its ancient university (founded in 1222) and made it the premier learning institution of their possessions.² Over the years Padua hosted eminent figures in science and humanities, including Francesco Petrarch, Pietro Bembo, Giacomo Casanova, and Nicolaus Copernicus.² The city was under the jurisdiction of the Venetian Senate, which encouraged learning and guarantee freedom of thought. Students and professors came from all over Europe. They made great advances in anatomy under Vesalius, Colombo, Falloppius, Casserio, and Fabricius of Acquapendente. Santorio Santorio promoted the quantitative approach to medical investigations, and Battista Morgagni introduced the clinico-anatomical approach to medicine. Alessandro Benedetti described the spread of syphilis (the Gallic disease) and Fracastorius (1476/8–1553) attributed it to living-like particles. Later, Georg Wirsung (1589–1643) described the major pancreatic duct.²

 

Infectious diseases

As a major trade center at the intersection of eastern and western Europe, Venice became victim to several epidemics. Hansen’s disease (leprosy) became prevalent and by 1182 AD patients were moved from central Venice to the island of San Lazzaro (named after its patron from the New Testament). Influenza came later as a highly and occasionally fatal infectious pandemic disease. Plague originated in central Asia and reached Venice in 1348, killing almost half of the city’s population. It took three clinical forms, the bubonic, pneumonic, and septicemic. By 1528 there had been at least fifteen outbreaks in the city, and while the wealthy were often able to flee the city, the poor had no choice but to remain, vulnerable in cramped and unhealthy housing conditions.

The outbreaks forced the authorities to quickly learn and adapt from its neighbors the most innovative means of disease control. From the near neighboring republic of Ragusa (now Dubrovnik), Venice imported the practice of quarantine, forcing people and ships to remain in isolation forty (quaranta) days before entering the city, and setting up inspections for signs of disease. From the Duchy of Milan it adopted the use of travel bans on goods and people from plague-affected cities. Life in Venice soon ground to a halt. Carnivals were cancelled; church services stopped; shops, inns, and taverns closed; and regulations were passed on how people were to be buried. The city was blocked off at the Rialto bridge and half of the population was isolated in their homes. Windows and doors of infected homes were boarded up to prevent the spread of contagion but with severe consequences for those imprisoned in their homes. By the sixteenth century, a doctor and a parish priest would be dispatched to people’s houses to question anyone suspected of showing signs of the disease. Sentries in the tower of the Piazza San Marco documented the comings and goings of ships on a daily basis. Galleys were sometimes directed to the Lazzaretto islands to unload goods for airing out and fumigation before they were allowed to be brought into the store houses of the city.

As early as 1423, Venice established plague hospitals, the Lazzaretto Vecchio and later the Lazzaretto Nuovo. Here patients were treated by lancing their buboes, bloodletting, and diverse oils, ointments, pills, and syrups made up with extracts of pearl, rosewater, poppy, and even urine. Facilities in these pesthouses were abysmal, with three or four patients to a bed. The 1510 outbreak took the life of thirty-year-old Giorgione, one of the city’s most celebrated painters, who died in the Lazzaretto Nuovo.

Later, waterborne cholera also devastated Venice. There were seven main pandemics. The sixth, known as the Asiatic Cholera or the “flow of bile,” spread from the Ganges through the trade routes of Asia to the coastal cities of the Mediterranean.

 

Drowning and tobacco

Perhaps less dramatic but common in an island city of more 140,000 people was drowning by falling into the canal from bridges and boats.³ People drowned while fetching water from wells, during storms, during epileptic fits, while trying to commit suicide, or as convicts trying to escape from the galleys. The risk was greater at night because there were no streetlights and fewer people available to effect a rescue. Most people could not swim, this being an elite pursuit of the rich like hunting and tennis.

Since the year 1300, victims of drowning were often resuscitated by insufflating air into the intestine. Using tobacco smoke instead of air became popular when tobacco came to Venice, the explorers of the New World having learned that indigenous populations used it for ulcerated abscesses, fistulas, sores, and headaches; as an antidiarrheal, narcotic, and emollient; for general bodily ills, colds, and fevers; and as an aid to digestion, a purgative, a narcotic, and as toothpaste mixed with chalk to whiten teeth.⁴ Tobacco became widely available in Europe and soon also began to be administered by rectal insufflation.⁴ A report from 1745 described how a man saved his wife’s life by putting one end of his pipe into her anus and blowing smoke into it with all his might until she recovered. Blowing tobacco up the nose had already been used for epilepsy and nervous headaches, and into the throat and ears for bronchitis, consumption, apoplexy, hemorrhoids, and lice.⁴ Soon smoke enema machines were mass produced wholesale, consisting of a bellows with a brass nozzle connecting them to a chamber where the smoke was generated. By the late 1790s there were resuscitation machines in 66 locations in Venice, and they were also used in Amsterdam, Florence, Hamburg, Paris, London, and Louisiana. The procedure was continued well into the 19th century.⁴

 

The medical care system

Over the years Venice developed a highly organized regulated medical care system controlled by the government and various colleges.^5-7 The sick could seek help from a variety of healers, learned physicians, surgeons, barber-surgeons, priests, and women. Distinctions between the often competing various groups of healers, guilds, and colleges were gradually established. A Venetian guild for physicians and surgeons had come into existence as early as 1258. By the sixteenth century there were separate colleges of physicians and surgeons. Physicians in the city had different identities, some being members of the College of Physicians and others not. The physicians’ training was theoretical, rather than practical, based on Galen’s humoral medicine, but pharmacists and barber-surgeons were trained through guild apprenticeships and took a more hands-on approach. Many physicians practiced surgery, but collegiate surgeons were not allowed to practice physic and could differentiate themselves from barbers.

Barber-surgeons were a very common figure in Venice, some performing surgery and using as their armamentarium a razor, scissors, tweezers, a stylet, some needles and a lancet for phlebotomy and lancing abscesses. Medical services were under the Department of Justice, the Giustizia Vecchia. In smaller towns, medical practitioners were often salaried by the government. Physicians and surgeons had to swear not to undertake any cure unless the sick man confessed his sins. They were periodically reminded of their obligation to treat the sick and wounded honestly, give counsel and succor, not act fraudulently to prolong illness, and not sell poisonous substances. Physicians were to avoid conflicts of interest when dealing with apothecaries, and apothecaries were forbidden to bribe physicians or surgeons to use their drugs. Before undertaking any treatment doctors were to inform the sick man of the cost and come to an agreement with him.

Medical education was also regulated.⁸ Physicians had to periodically update their education in a manner similar to modern continuing medical education. Professionals from the University of Padua were admitted automatically to practice medicine in Venice. Public doctors salaried by the government were usually surgeons and were required to live in a specified area, They were to administer blood-letting and cupping-glass treatments free of charge, visiting first-time patients free of charge and filing legal reports in criminal cases. In addition, they had to run the public pharmacy. By the mid-1500s, Venice boasted over fifty apothecaries, relying heavily on the production and sale of a variety of medicaments.

In the 18th century the city had achieved considerable administrative competence in many essential matters including healthcare. The health authorities would regularly send out printed notices to its population and to its physicians outlining instructions, offering rewards for successful procedures, and even punishment for noncompliance. The treatments offered to patients were generally in line with those of other Western European countries.

 

Epilogue

After its 1509 defeat and the rise of Turkish supremacy in the East, Venice no longer ruled the waves of the Mediterranean. Eventually it also lost its supremacy in northern Italy. Yet for a long time it remained one of the dominant cities in Europe in science, culture, and health care, its achievements even more remarkable than when it was a great world power.

 

References

1. John Julius Norwich: A History of Venice.
2. Zampieri F, Zanatta A, Elmaghawry M, et al. Origin and development of modern medicine at the University of Padua and the role of the “Serenissima” Republic of Venice. Glob Cardiol Sci Pract. 2013; (2): 149–162.
3. Charlton A. Medicinal uses of tobacco in history. JR Soc Med.2004;97:292.
4. Bamji A. Blowing smoke up your arse: Drowning, resuscitation, and public health in eighteenth century Venice. JR Soc Med.2020;94:29.
5. Jenkins, C. Curing Venice’s plagues: pharmacology and witchcraft. Postmedieval 2017;8:202–208.
6. Bamji A. Medical Care in Early Modern Venice. J Social History, 2016; 49: 483.
7. Bartolini, D: On the Borders: Surgeons and their activities in the Venetian State (1540-1640) Medical History; 2015; 59:83.
8. F Zampieri, A Zanatta, M Elmaghawry et al. Origin and development of modern medicine at the University of Padua and the role of the “Serenissima” Republic of Venice. Origin and development of modern medicine at the University of Padua and the role of the “Serenissima” Republic of Venice. Global cardiology science & practice 2013 (2), 149.
9. Ell S Five Hundred Years of Specialty Certification and Compulsory Continuing Medical Education. Venice 1300-1801. JAMA 1984;251:753.

 

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GEORGE DUNEA, MD, Editor-in-Chief

 

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