A Sixteenth-century Physician and His Patients: The Practice Journal of Hiob Finzel, 1565–1589

A Sixteenth-century Physician and His Patients: The Practice Journal of Hiob Finzel, 1565–1589 Summary This paper presents the results of a detailed analysis of the most extensive practice journal by far that is known to have survived from any medical doctor in sixteenth-century Europe. Over a period of almost 25 years, Hiob Finzel, town physician first in Weimar and later, for most of his professional life, in Zwickau recorded more than 10,000 consultations. Looking at the age and gender of his patients in Zwickau, we find a predominance of male patients and a remarkable number of infants and children. While only a minority of (mostly upper-class) patients consulted Finzel regularly, an analysis of the patient’s professions (viz. that of the respective bread-winner) and the very moderate fees they paid shows that Finzel’s services were accessible to and called for not just by a small urban elite but by large parts of the population, including many artisans and country folk. medical practice, practice journal, town physicians, patients, Hiob Finzel Introduction Learned physicians played a growing role in sixteenth-century society and health care. Not only were they able, based on their thorough training in the liberal arts and in natural philosophy, to establish themselves as a major group within the res publica litteraria; they also found increasing recognition as medical practitioners. German and Swiss town magistrates, by the 1550s, almost routinely preferred their services to those of a non-academic barber-surgeon when they appointed a medical practitioner as Stadtarzt.1 Contemporary autobiographies and personal correspondences indicate that on the European continent, at least among the urban upper classes and the nobility, physicians enjoyed considerable trust and frequently were the first choice when someone in the family got sick.2 While the scholarly activities of sixteenth-century physicians and their extensive participation in epistolary networks are well documented, rather little is known about ordinary learned medical practice and the average physician’s day-by-day activities. Who consulted an academic physician rather than a barber surgeon or another less learned practitioner? Did learned physicians, as historians have claimed for a long time, cater almost exclusively to the rich and mighty? Or did they treat patients from many walks of society, as others have more recently suggested? For what kinds of complaints or diseases were they consulted? What could they offer? Is it true that physicians, as Hal Cook has argued for early modern England, gave ‘much advice and little medicine’?3 Last but not least, how did physicians fare economically? To what degree could they make a living from their medical practice? Unfortunately, sources that reflect physicians’ actual practice—rather than general, theoretical ideas about medicine and different diseases—are very limited. Among printed sources, collections of curationes and observationes offer valuable information about the ways in which individual physicians diagnosed and treated patients and, to some degree, about the patients who consulted them.4 Most of these collections can be taken to reflect ordinary learned medical practice only to a rather limited degree, however. Their authors were almost inevitably very successful or indeed famous physicians—otherwise, they would have found it difficult to publish their observationes. Even more importantly, most of them selected, from the many patients they had seen, a certain number—and sometimes a very small number indeed—of particularly revealing, interesting or ‘rare’ cases for publication.5 In making their choices, they were inevitably also guided by their desire to highlight their personal diagnostic and therapeutic skills and the high social standing of the patients who sought their advice. A much more reliable guide and indeed the best source, by far, for the ordinary practice of learned physicians in that period and for the patients who consulted them are practice journals. Probably many early modern physicians kept such journals, in which they recorded, day by day, the patients they saw, adding varying amounts of further information: the patients’ complaints, the diagnosis, the medicines they recommended, the payment they received, the patients’ profession, age, sex, place of residence. Because of the wealth of data that can be gleaned from practice journals, they have attracted growing attention over the last few years.6 Only recently, the major results of the collaborative work of a total of eight research groups of a German-Austrian-Swiss research network on medical practices from the seventeenth to the late nineteenth century have been published, with each group taking a practice journal (or a collection of practice journals) as the starting point.7 For the time before 1600, the situation is particularly difficult, in terms of identifying suitable sources. Lauren Kassell’s survey of early modern medical case books in England has shown that very few manuscripts from ordinary, orthodox physicians have survived from this early period that can be described, at least in a wider sense, as casebooks—basically there are only a couple of remedy lists that also indicate the patients’ names and the miscellaneous notes of a Hampshire physician that include some cases.8 Kassell also directs the Cambridge Casebook Project, which is in the process of putting the casebooks of Simon Forman and Richard Napier online, by far the most extensive casebooks that have so far been identified for the sixteenth and early seventeenth centuries and a fascinating source. However, although Forman and Napier, being learned men, may well have been taken for ‘doctors’ by many of their patients, they were not trained physicians and theirs was primarily an astrological practice.9 Sources are similarly rare for learned physicians on the European continent. For sixteenth-century Germany, the only notable exceptions that have so far been made known are two journals by Georg Palm, which are largely limited to listing the recipes he prescribed, and some fragments, covering only several months, of that of Johann Magenbuch, both physicians in Nuremberg.10 The extensive notes that the Bohemian physician Georg Handsch took on the patients that he and his colleagues saw and treated in and around mid-sixteenth-century Prague and later in Innsbruck offer many new insights into the doctor–patient relationship and the mutual exchange of medical knowledge between doctors and patients at the time. However, Handsch only recorded the cases of those patients—sometimes in day-by-day accounts—which he deemed in some way particularly noteworthy.11 In light of all this, the principal source on which this paper will draw is unique: three heavy folio volumes in which the German town physician Hiob Finzel recorded more than 10,000 consultations over a period of almost 25 years, from 1565 to 1589.12 Until now totally overlooked by historians, this is by far the most extensive and complete known record of the practice of any individual learned physician in sixteenth-century Europe. The source is all the more valuable because there is little to indicate that Finzel’s medical practice was exceptional or untypical. Finzel—or Iobus Fincelius as he usually called himself in writing—is a well-known figure among historians of German literature and popular culture. He was the author of the Wunderzeichen, a wide-ranging collection of accounts of portents, miracles and other spectacular events, that Finzel, a devout protestant, presented as divine admonitions that humankind must change its ways.13 This work predates Finzel’s move into medicine, however, and there is nothing to suggest that his later situation and work as a town physician in medium-sized towns like Weimar and Zwickau differed substantially from that of many other learned town physicians at the time. My analysis will start with a biographical sketch and will proceed to present Finzel’s practice journal as my principal source. The bulk of this paper will then be devoted to a quantitative and qualitative analysis of Finzel’s entries, looking at the kinds of patients who sought his advice, their profession or social status, their age and sex and their medical conditions, and at their relationship with the learned physician. Hiob Finzel Interest in Finzel as the author of the Wunderzeichen has led historians to look for sources on his biography, but very little was known so far about his later years, when he worked as a medical practitioner.14 His journal and some newly found letters also throw new light on this part of his life. Hiob Finzel was born, probably around 1526, in Weimar.15 He studied the liberal arts in Wittenberg and graduated there in 1549.16 From 1549, we find him lecturing on natural history in the Gymnasium academicum in Jena, where he served as a professor once the Gymnasium became a university in 1558.17 During this period, Finzel sought to establish himself as a humanist scholar and poet. He translated the elegies of the Greek poet Tyrtaios and published various poems of his own, and he worked on his Wunderzeichen.18 By the time the last part of the Wunderzeichen came out, Finzel had already turned to medicine, however. Such a relatively late turn towards medicine was not uncommon at the time, especially among scholars who began lecturing in the arts faculty once they had obtained a master’s degree.19 In Finzel’s case—and the same is presumably true for other physicians—this decision probably reflected the greater degree of economic security that learned physicians tended to enjoy, compared to scholars well versed in the studia humanitatis but without a particular professional training. In December 1562, Finzel received his medical doctorate in Jena, defending a thesis on the plague.20 In the spring of 1564, he was appointed as a town physician in Weimar for three years. When his contract was not renewed in 1567, he worked for some time in private practice and, from 1569 until 1571 as a court physician in Eisenach.21 Finally, in April 1571, he was appointed as a town physician in Zwickau. His contract obliged him to serve the town and its citizens, to perform an annual visitation of the local pharmacies and to advise the sick in the hospitals and sick-houses out of ‘Christian charity’, that is, presumably for free.22 Like many of his colleagues in other towns, he was not allowed to leave the town over night without the mayor’s permission.23 Finzel began working in Zwickau in July 1571 and he was to remain there for the rest of his life.24 Finzel had found his place, as a pater familias with a growing family, as well as professionally and economically. Zwickau was a fairly prosperous town with a strong tradition in cloth production and some sizeable mining activities in the area. In a letter to the captive Duke Johann Friedrich of Saxony—whose wife and children he had cared for in Eisenach—he wrote in June 1572 that he had never had such a ‘stately’ practice.25 Finzel’s Practice Journal The entries in Finzel’s practice journal start in April 1565 when he was still a town physician in Weimar, and they end shortly before his death, in 1589.26 Finzel did not use an album, a book with empty pages, for his journal but wrote on little fascicles or individual sheets of paper. There are no empty pages at the end of any of the three volumes and they have an (almost) identical binding. This, occasional mistakes in the chronological order of the fascicles and the fact that the notes extend until shortly before his death, strongly suggests that they were bound in three folio volumes only after his death. We do not know how the manuscript came into the possession of the Ratschulbibliothek. The most likely explanation would seem to be that another physician—maybe Peter Poach, Finzel’s successor in Zwickau—considered these notes as potentially useful and had them bound, and that they were later given to or acquired by the Ratschulbibliothek.27 During the first couple of years, the entries in Finzel’s journal are dated only sporadically. From 1572, Finzel marked the beginning of every new year and indicated the respective month on the top of each page. It is because of this strictly chronological organisation that I use the term ‘practice journal’ here rather than the well-established but more generic term ‘casebook’. A practice journal—certainly one like Finzel’s that is not limited to just listing names and dates but also gives information on the individual cases—is a casebook. However, not every casebook is also a practice journal: the term ‘casebook’ can refer to any collection of medical cases or case histories, including heavily selected ones and collections in which cases are not sorted chronologically but according to diseases or body sites.28 As a rule, each entry in Finzel’s casebook seems to have corresponded to a single consultation. Even when patients consulted him only a couple of days later, Finzel made a new entry, and occasionally two entries on the same patient follow one right after the other, with headings like ‘idem’ or ‘dieselbe’ (‘the same’). The length of the various entries and the amount of information Finzel recorded vary considerably (see Figure 1). A complete entry comprises: (1) the name of the patient viz., in the case of wives, children or servants, usually that of the husband, father or employer, (2) the bread-winner’s profession or, in the case of noble patients, the title or military rank, (3) the place of residence, (4) the diagnosis, (5) the medicines Finzel prescribed, and (6) the payment he received. Fig. 1. View largeDownload slide Double-page from Finzel’s practice journal, September 1573 (RSB Zwickau, Ms. QQQQ1, 62–63) Fig. 1. View largeDownload slide Double-page from Finzel’s practice journal, September 1573 (RSB Zwickau, Ms. QQQQ1, 62–63) In only a minority of the entries, did Finzel provide information on all six points, however. Numerous entries are limited to some kind of identifying information (name, profession, or place of residence, or indeed just ‘rusticus’ or ‘man’), the medicines given and the payment received. From this, the two principal functions of Finzel’s journal can readily be recognised. First, it was an account book. In fact, the journal was archived among the manuscripts of the Ratschulbibliothek under the title Rationarium, that is, ‘account book’, and this may be a major reason why historians have overlooked it. Even when he recorded no other information on a certain patient, Finzel usually indicated the payment he received for his services, and he used these entries to calculate his annual earnings at the end of each year.29 The second major function of Finzel’s patient journal was to record his diagnosis and his prescriptions and sometimes, but much more rarely, the indicationes curativae, that is, the reasons why he chose particular medicines and what effect he hoped to achieve with them. The recipes of his prescriptions constitute the bulk of most entries. While Finzel rarely recorded dietetic recommendations—leave alone a detailed regimen—he relied heavily on medicines. Presumably, he copied the recipes, which had to be taken to the pharmacy, into his journal. The recipes (see Figure 1) began with the familiar sign for recipe and listed (in Latin) the various ingredients with their respective quantities and concluded with the (German) term with which the pharmacist was to label it, such as ‘Hertzwasser’ (‘cordial’). Here, the journal served primarily as a mnemonic tool: if a patient consulted Finzel again, in the course of the same disease or when he or she later came down with another disease, Finzel could easily find out what he had told the patient and which medicines he had prescribed.30 The journal’s mnemonic function is underlined by about 130 entries on Finzel’s treatment of diseases in his family and of his own diseases, for which obviously no payment is recorded. A third major potential use of early modern patient journals was to improve diagnostic skills and/or therapeutic outcomes by assessing, retrospectively, whether the physician’s diagnosis and prognosis had proved correct and how well the medicines had worked. This is a function that patient journals have in common with the less systematic, casuistic notes in the notebooks of some other sixteenth-century physicians such as those of Georg Handsch.31 In Finzel’s journal, by contrast, this use played only a marginal role. He rarely documented the effect of his treatment. When he did it was mostly to note how well the laxatives he frequently prescribed had worked in the individual case (‘12 stools on the first day’, ‘8 sedes’) or that a patient had found the laxative to be ‘too strong’.32 Finzel’s practice journal also had very little in common with a personal diary. Only a couple of times did he note important personal events, such as his move from one place to another or the birth of one of his children.33 Notes on political events such as the conflicts between the French king and the Prince of Conde are likewise rare exceptions, as is the harsh moral judgement on the wife of one of his most prominent patients, Heinrich von Enda: ‘She turned into a whore this year’.34 Finzel’s Patients For the purpose of quantitative analysis, all entries in the three volumes of Finzel’s practice journal were entered into a tabular database.35 In what follows, my analysis will focus on the time period from January 1572 until December 1588, a few months before his death, the major and rather stable period in Finzel’s professional life as a physician.36 When we look at the numbers, an important distinction between two different sets of data must be kept in mind, namely that between figures referring to the total number of consultations and those referring to the number of individual patients. Since Finzel saw many patients more than once, the number of individual patients is considerably smaller than that of the consultations. In the 17 years from 1572 to 1588, Finzel recorded a total of 8,746 consultations, not including about 130 entries that referred to himself and his family.37 This means, on average, 516 consultations per year (see Figure 2). With 681 consultations in 1572, not even a year after his arrival in Zwickau, and 790 consultations in 1573, he could already boast a highly successful practice. In Weimar, he had only recorded about 320 consultations per year.38 Georg Palm, in Nuremberg, recorded an average of 118 consultations per year, from 1583 until 1591.39 Finzel clearly did not experience any initial difficulties in gaining a reputation and attracting patients, which were described, at the time, as virtually the inevitable fate awaiting a physician who set up a practice in a new locality. The relative lack of competition, his trust-inspiring age—he was already in his forties—and, above all, his good social connections − he had married the daughter of the mayor of Zwickau, Wolfgang Mühlpfort—probably played a major part in this success. Fig. 2. View largeDownload slide Annual number of consultations in Hiob Finzel’s Zwickau practice (1572–1588) Fig. 2. View largeDownload slide Annual number of consultations in Hiob Finzel’s Zwickau practice (1572–1588) Beginning in the late 1570s, we find a decline in the annual number of consultations, gradual at first and then, from 1585, quite significant (Figure 2).40 In economic terms, this decline was offset to some degree by higher fees, however. Since we have no evidence of increased local competition or health problems on Finzel’s part, the reasons remain unclear. Complaints and diagnoses In about 4,000 of his entries, Finzel recorded the diagnosis. Sometimes the diagnosis reveals, at least indirectly, which complaints led the patients to seek his advice. In about 500 entries, the primary diagnosis was some kind of fever. At the time, ‘fever’ was not synonymous with an increased temperature and physicians distinguished different types of fever, such as tertian, quartan or putrid fever, but ‘fevers’ were commonly associated with feeling hot and a general sense of weakness. About 80 times Finzel recorded pain, especially headaches, around 70 times dropsy, around 50 times bladder- or kidney-stones, around 40 times pleurisy, around 35 times coughing and around 20 times each epilepsy, jaundice and asthma. Only 10 patients were diagnosed with podagra or gout, a disease which has widely—and thus possibly wrongly—been taken to be the quintessential sickness of the age. In most cases, Finzel’s diagnosis does not reveal the actual symptoms or complaints, however, that had prompted the patients to seek his help. Like many other learned physicians of the time—this was, for example, what medical teaching in Padua in the tradition of Giovanni Battista da Monte was famous for—he sought to identify the pathological processes inside the body, which he considered, in turn, responsible for the patient’s complaints and for the changes that could be observed from the outside.41 As was typical for a Galenist physician of his time, the diagnostic terms that he used for the large majority of patients circled around notions of impure, corrupt matter and around the processes that led to its production and accumulation, on one hand, and its insufficient movement to and excretion through the natural pathways, on the other.42 On roughly 500 occasions, he recorded a cruditas as the major problem, that is, crude, corrupt humours, which accumulated in the body or in certain parts. Within the Galenic system, such crude humours could result, in particular, from an insufficient ‘concoction’ of food, which was due, in turn, above all to a weak or cold stomach, a diagnosis Finzel reached in another 120 entries. About 160 times he found an ‘obstruction’ or ‘oppilation’, mostly in the mesenteric vessels or in the liver. More than a 100 times he diagnosed a ‘catarrh’. The term is still familiar today but it had a different meaning in Finzel’s time: it referred to any disease the physician attributed to fluid morbid matter that originated from the head or brain. Sometimes the morbid matter might flow down into the nose or into the trachea and the lungs, causing coughing and sneezing, thus roughly matching our modern understanding. Frequently the morbid matter settled in other parts of the body, however. Finzel diagnosed patients with a ‘catarrh’ towards an arm, a foot, to the pelvic bones or the back or even declared a ‘catarrh’ to be the cause of a paralysis. The most common diagnosis by far was reserved for women—and it is a rather surprising one: praefocatio or suffocatio matricis, the suffocation of the womb. In more than a thousand entries, this was Finzel’s principal diagnosis. Medical historians have taken the ‘suffocation of the womb’ to be largely synonymous with ‘hysteria’ or ‘hysterical symptoms’—which Finzel diagnosed in another 100 cases (and sometimes in combination with a ‘suffocation of the womb’).43 More research on the precise meaning of these terms is needed, based in particular on practice notes and other casuistic sources.44 It seems extremely unlikely, however, that so many of Finzel’s female patients complained of the attacks of shortness of breath caused by an ascending uterus to which the term ‘suffocation of the womb’ was usually taken to refer. A look at the etymology may be more helpful here: The term ‘hysterical’ is derived from the Greek word for the uterus. A humanist physician like Finzel, well versed in Greek, may thus simply have used the expression ‘hysterical symptoms’ to refer to all those whose origin he located in the uterus. Along similar lines, Finzel presumably used the term ‘suffocation of the womb’ in a much wider sense, namely as a generic term for the manifold effects of harmful vapours which were taken to arise from the uterus, when menstrual blood or the seed (which Galenic physicians also ascribed to women) corrupted or putrefied in the uterus, due to a retention of the menses or an insufficient evacuation of seed, for example in virgins and widows.45 Vapours or fumes were a very important and familiar concept in early modern learned medicine. Depending on their movement in the body, they could be responsible for a wide range of symptoms. They could cause pain in certain areas, like the pain in the mouth of the stomach, which Finzel, in Frau von Auerswald, attributed to ‘a consensus with the uterus and fumes ascending from it’.46 Finzel’s prescriptions and the countless medicines he used deserve a closer analysis in their own right. Like most physicians at the time, he based his treatment primarily on medicinal plants, which he mixed in certain quantities to produce the desired effect on the body. Often he only prescribed one (composite) remedy but frequently he also wrote, during a single consultation, different recipes for the same patient. The precise rationale behind his prescriptions frequently remains unclear but the German terms used to label them and his occasional notes on the indicationes curativae that guided his prescriptions indicate that Finzel’s therapeutic approach was generally in line with the principles of the Galenist methodus medendi as it was taught in the leading universities of the time.47 In order to achieve a true, ‘radical’ cure, a cure, that is, that fought the disease at its very roots, the physician had to identify the nature, source and location of the morbid matter in question, eliminate it and fight the underlying cause, for example an ‘obstruction’. The rationale underlying the physician’s diagnosis and treatment could be quite complex. When Dorothea von Schönberg, for example, suffered, amongst other problems, from severe coughing and putrid sputum and sometimes coughed up blood, he suspected a pulmonary ulcer. Finzel assumed that the morbid and, in this case, sharp aggressive matter flowed down into the lungs from the brain. From this he took his indicationes curativae: he sought, above all, to change the nature of the morbid matter in the brain itself, by making it milder and promoting its concoctio, to support its evacuation through the mouth and the nose by means of medicines the patient had to chew viz. put into her nose, to divert the flow of the matter away from the lungs towards the arm by means of a vesicatory and to prevent the production of further matter by remedies that dried the brain.48 The overwhelming majority of Finzel’s patients suffered from complaints that, according to Finzel’s diagnosis, reflected pathological processes deep inside the body. Such diseases, which had to be treated in turn by giving medicines that acted inside the body, were the privileged domain of the learned physician. ‘External’ diseases, by contrast, which were, at the time, considered the realm of surgery only, played a minor role in Finzel’s practice. Presumably, the patients preferred the advice of a barber surgeon in such cases. Finzel recorded four cases of hernia. A girl in the hospital had a large ulcer and a fistula on her leg. Two patients had suffered ‘injuries’. Somewhat more frequently, patients with morbid skin changes sought his advice. Finzel diagnosed about 20 patients as scabiosi and a dozen patients, including two women, as suffering from the French disease (‘morbus gallicus’, ‘morbus syphilis’). Due to their superficial, external manifestation, skin changes were usually considered the domain of surgery but their ultimate causes were frequently located in the body: the skin changes were taken to reflect the body’s attempt to eliminate some kind of morbid matter through pustules, rashes, ulcers and the like and they would only stop when the source of the morbid matter was eradicated—which was the physician’s task. Obstetrics—like pediatrics—attracted growing attention in learned medical writing at the time.49 Finzel was rarely consulted for health issues associated with pregnancy, birth and childbed but his journal indicates that the learned physician was certainly well advised to acquire some knowledge in that area as well. Three of his consultations were for a ‘difficult birth’ (difficilis partus)—two of them, in two consecutive years, for the Frau von Planitz, one of the foremost noble families in the area. Several women sought his advice for postpartum conditions such as a placenta that had partially remained in the body or for feeling hot (or feverish) due to an insufficient excretion of the lochiae (calor ex retento sanguine tempore partus). Age When we look at the age of Finzel’s patients, an initial remarkable finding is the considerable number of very young patients in Finzel’s practice. Historians have widely assumed that learned physicians in the early modern period rarely treated infants and children.50 Finzel’s journal ultimately confirms this finding but yields a more nuanced picture. Finzel recorded 94 consultations for an infant and 78 for a child (‘Kindelein’, ‘Kind’). In addition, there are 35 entries which refer to a ‘little son’ (‘filiolus’, ‘Söhnchen’) and 64 for ‘little daughter’ (‘filiola’, ‘Töchterlein’, ‘Megdlein’), an epithet Finzel used with his own daughters until they were about ten. When we add these entries, we arrive at a minimum of 271 consultations for infants and smaller children. Their number may well have been higher: Finzel recorded a further 83 consultations for ‘boys’ (‘pueri’) and 272 for ‘girls’ (‘puellae’), although some of the latter suffered from menstrual disorders and were thus at least in puberty. Moreover, other entries, which only give a name or recorded a patient as someone else’s son or daughter, may also have referred to children. We have no reliable data on the proportion of children among the general population but, compared to the total of 8,746 consultations, infants and children were by all appearances massively underrepresented in Finzel’s practice. Yet even the relatively small number of those whom Finzel explicitly described as infants and small children demonstrates that parents sometimes did seek the help of a learned physician for the very young—and that the physician needed the appropriate skills. This is confirmed by other sources. As Franziska Ofenhitzer has shown in her analysis of the prescription diary of Petrus Kirstenius in Breslau (October 1612 to December 1616), for example, about 18.5 per cent of the patients for whom he wrote a prescription were children.51 Consulting a learned physician for children’s diseases was somewhat more common among the upper classes but it was not limited to them. A total of 36 out of 94 consultations concerned infants from noble families but Finzel also recorded consultations for the infants of a baker, a barber, a barber surgeon, of several rustici and for about a dozen infants who are only identified by their hometown or village, which suggests that they did not come from well-known, prominent families either. Five consultations were for the infants of pastors and these highlight that churchmen, like everyone else, were not necessarily willing to trust only in God even with such very young patients. Gender Among the 8,564 consultations for patients whose gender can be identified male patients predominate with 4,863 consultations (56.6 per cent) against those of women (3,701 or 43.4 per cent).52 This was not unusual. In Palm’s practice, the proportion of men was even higher, with 63.4 per cent men versus 36.6 per cent women, and Ofenhitzer’s analysis of Petrus Kirstenius’ prescription diary in early seventeenth-century Breslau, leads to a ratio of 70.7 per cent to 29.3 per cent (Figure 3).53 Fig. 3. View largeDownload slide Proportion of female and male patients in physicians' medical practices Fig. 3. View largeDownload slide Proportion of female and male patients in physicians' medical practices The reasons are unclear. It seems unlikely that men were sick more frequently or more seriously than women. Neither is there much evidence that the health of men was generally perceived as more important than that of women, although this remains a possibility. Most likely, women more often than men preferred a non-academic healer and, in particular, a female one to a learned physician, and they may also have resorted more frequently to domestic remedies.54 Social status The figures given above referred to the number of consultations. When it comes to social status in particular, it is crucial, however, that we also establish the number of individual patients: patients from certain social groups may have sought a physician’s advice more frequently than others. I have therefore assigned a single patient-ID to entries on different consultations that clearly or at least very likely referred to the same patient. This process is inevitably fraught with a considerable margin of error. On the one hand, Finzel did not always record a specific patient the same way—or even write his or her name in the same manner. On the other hand, two different patients may be taken for one, because Finzel sometimes only wrote the last name of a patient (or of the patient’s husband or father), such as ‘Cuntz’ or ‘Lowasser’ or ‘Tobrissen’s wife’ or only the profession and place of residence, such as ‘baker in Berndorf’. Obviously, there may have been more than one Cuntz, Lowasser or Tobrissen in the area and more than one baker in Berndorf.55 Fortunately, the total number of patients in Finzel’s journal is quite large and most of them are identified very clearly, which reduces the effects of individual errors on the validity of my general conclusions. Within these methodological limitations, we arrive at a total of 6,551 different patients who sought Finzel’s advice over a period of 17 years. This figure already represents a striking finding in itself. For a long time, historians have assumed that learned physicians in the early modern period treated only a small minority of upper-class patients who sought their advice and could afford to pay for it.56 More recently, some historians have suggested that learned physicians, already by the sixteenth century may have appealed to a much wider segment of the population.57 Finzel’s journal offers, for the first time, precise data that substantiates this claim. Zwickau was a medium-sized town with not even 10,000 inhabitants.58 Even though Finzel also treated many patients from the surrounding locations with an unknown population, the sheer number of more than 6,000 different patients indicates that considerable parts of the population—and not only the rich elite—at one point or another asked Finzel for advice. What is more, Finzel was not the only learned physician in Zwickau. The data is scant but a systematic survey of contemporary lists of house- and land-owners in Zwickau reveals that Eusebius Wildeck, Finzel’s predecessor as a town physician still lived there—and presumably practised—at least until 1577. From 1580, Christoff Sehling is documented; he came as a young physician from the nearby mining town of Schneeberg; eventually even serving as mayor of Zwickau, from 1587 until 1595.59 If Finzel alone treated more than 6,000 different patients over the course of 17 years, there can be no doubt that large parts of the population, at one time or another, sought the advice of a learned physician. This conclusion is corroborated by the many entries that include references to the patient’s status or profession or in the case of women and children to that of the male bread-winner. As many as 511 patients or close to 8 per cent came from noble families—but more than 92 per cent did not.60 For around 3,000 of these remaining patients Finzel recorded the profession of the patient (viz. that of the husband, father or, more rarely, employer) or other indicators of social status and economic background. Among them, we find mayors, members of towns councils and administrative officers and we find the literate elite: teachers and, above all, about 170 patients from the households of pastors. A group of 50 patients were identified in generic terms as being (or belonging to the family of) a ‘citizen’ (‘civis’). We also find hundreds of more ordinary people, however. Dozens of patients were or came from the families of artisans and journeymen with professions such as tanners (10), shoemakers (6), millers (19), butchers (18), fishermen (5), coachmen (9), black-, hoof- and nail-smiths (25), potters (20), tailors (16).61 Others worked as innkeepers (17), bookbinders (1), bee keepers (2), messengers (2), gun makers (1), hangmen (1), scissor sharpeners (2), fiddlers and organ players (11), organ makers (4), glassmakers (1), goldsmiths (5), coppersmiths (1), nail smiths (1), paper makers (5), cooks (4), candle makers (1), cowherds (2) or fur makers (5). A small number, 23, are recorded as ‘poor’ or as hospital inmates, 31 patients were referred to as farmers or working for a farmer; while 702 patients were simply recorded as ‘country folk(s)’ (‘rusticus’, ‘rustica’).62 As the sheer number of patients and, where Finzel recorded them, the patients’ professions show, people from virtually all walks of society sought Finzel’s advice.63 Since Finzel’s contract did not include the free treatment of patients (except for hospital inmates), this suggests that many, if not most people—and not just a small elite—were able to afford his services. Finzel’s detailed records of the payments he received show that this was indeed the case. Some upper-class patients paid considerable sums—two, three, five or even more gulden for a single consultation and sometimes rewarded the medical treatment of their maidens and servants with similar generosity.64 For infinitely more patients, however, Finzel noted ‘g i’, or ‘g ii’, that is, 1 or 2 groschen, and the large majority of his patients did not pay more than 3 groschen for a consultation. Prices and monetary values are notoriously difficult to compare over time but Finzel’s own assessment of the monetary value of different edibles that patients gave him and other contemporary sources give at least a rough idea. According to Finzel’s calculations a hare was the equivalent of 6 to 8 groschen, and that of a big cheese 9 groschen. Several birds cost 7 groschen, a good calf including the tail, was worth roughly 80 groschen. According to other contemporary sources, around 1560, in the area around Hamburg and Lübeck, a chicken cost 1 groschen, ten eggs a bit less than that, and a pound of butter 1.5 groschen. In 1580, in Mecklenburg, one chicken was 1.5 groschen, a goose cost a bit more than 3 groschen; a journeyman in carpentry got 4 groschen a day, a thresher 1.5 groschen and food.65 Prices in Zwickau may have been somewhat different, but clearly most people would have been able to afford 1, 2 or even 3 groschen for a consultation. The Doctor–Patient Relationship The large number of different patients in Finzel’s practice and the modest social status of the majority of them raises intriguing questions, in turn, about the nature of the early modern doctor–patient relationship. When we compare the number of 8,746 consultations with the number of individual patients, 6,551, we find that Finzel recorded, on average, only about 1.34 consultations per patient. In other words, Finzel saw the large majority of his patients only once or twice. The figure for Palm’s practice in Nuremberg is not much higher. From June 1583 until April 1591, Palm recorded only 929 consultations for 380 patients, or a little more than 2.4 consultations per patient.66 In the mid-seventeenth century, Johannes Magirus in Zerbst recorded about 266 consultations for 97 patients, that is, about 2.75 consultations per patient.67 With female patients, especially, and with patients who lived in places outside of Zwickau, viz. Weimar, Finzel frequently does not even seem to have known—or remembered—their names. About 20 consultations are quite simply recorded as being for a ‘man’ (‘Man(n)’ and—the difference is very striking—522 for a ‘woman’ (‘Frau’) or a ‘girl’ (‘Jungfrau’, ‘puella’), usually together with their place of residence. Likewise, for about 550 of the 702 patients whom he recorded as ‘rustici’, we do not find a name but, at best, the place of residence. Presumably—but on this we have no specific information—many rural patients came to see Finzel in Zwickau, rather than calling on him to visit them in their homes. Three entries in his journal—including two from his time in Weimar—state explicitly that he only saw a patient’s urine without even indicating whether it was from a man or a woman. However, in view of the very common practice of uroscopy, Finzel may often have only seen the urine of his rural patients but not the patients themselves.68 All this does not suggest a particularly close and personal relationship and stands in marked contrast to the familiar image of the premodern physician who took care of his patients from the cradle to the grave and almost became part of the family. Many patients, it seems, were one-time customers rather than faithful patients. They were not looking for continuous treatment but they simply gave the physician a try. If his medicines worked that was fine—and if not they moved on to another medical practitioner. Once we look at patients of different social status, however, Finzel’s journal indicates that the image of the physician who took care of whole families and became a familiar figure in their homes is not pure fiction either. While many if not most people, at one point or another, consulted Finzel, his journal suggests that an ongoing therapeutic relationship that lasted over a period of years was primarily an upper-class phenomenon. Some patients from the higher ranks of society and especially from the aristocracy consulted him quite regularly, or, in certain cases, even dozens of times. Sometimes this was due, at least in part, to repeated consultations for one disease episode. For example, Finzel recorded 10 consultations for Wolf Rudolf von Planitz just from January to June 1572 and another 10 consultations in January and February of 1574, when he seems to have suspected the French disease, which called for fairly intensive treatment. Other noble patients called on Finzel’s services only every once in a while but for long periods of time. Christof von Oelsnitz, for example, consulted Finzel 31 times, from December 1572 until September 1587. Moreover, he frequently treated, at various times, different members of the same noble family. In fact, almost 60 per cent of his consultations for noble patients concerned members of only ten families: Albrecht (30), Auerbach (25), Enda (87), Kauffungen (50), Oelsnitz (53), von Planitz (197), Trutschler (23), Weisbach (199), Widebach (23), Wolframsdorf (51). Among these two—the Planitz and the Weisbach—stand out, in turn, with almost 200 consultations each. Here Finzel came, at times, close to serving as a family physician—even though different members of that family did not necessarily live in the same household. For a few noble families Finzel even recorded a ‘salary’, which he received at regular intervals. Wolf von Weisbach gave him 7 taler as a ‘half-year salary’, from Jörg Albrecht von Witzleben he received 30 gulden per year, and Heinrich von Enda paid him 10 taler for half a year.69 Yet, even for the upper classes, Finzel’s entries suggest a doctor–patient relationship that frequently was not particularly personal. With only about 2.5 consultations per patient (1,256 consultations for 493 patients), contacts were quite sporadic, on average, even among the nobility. Moreover, in about 40 consultations for his noble clientele (27 women and 15 men) he did not even identify the patient with his or her the name but only wrote ‘nobilis’, ‘nobilis puella’, ‘quidam nobilis’ and similar terms. All in all, a picture of the doctor–patient relationship emerges from Finzel’s journal that is quite different from what we have become accustomed to imagine. It was a relationship that was often much less personal and much less based on the kind of mutual trust that could build up from years of interaction—and remarkably reminiscent of patterns of behaviour in modern health care that have come to be described as ‘doctor shopping’. Conclusion Analysing thousands of entries in a patient journal is inevitably laborious and time-consuming. As I hope to have shown in this paper, it is also highly rewarding. It allows us to test and challenge well-established historiographical claims about early modern medical practice and the doctor–patient relationship, claims that have usually been based only on anecdotal evidence or on sources that reflect very specific groups of doctors and patients. To start with, Finzel’s journal—like Kirstenius’ prescription diary and Handsch’s extensive notes on the medicinal treatment of patients—confirms what is suggested already by the widespread interest in simples and the very lively circulation of medicinal recipes among physicians at the time: learned medical practice relied heavily on medicines (plus minor surgical interventions such as blood-letting and cupping). The dietetic tradition remained very much alive, especially in health advice books.70 Finzel very occasionally did record some dietetic advice, for a high-ranking patient, and we find the same in Handsch’s case notes. Moreover, regimens that were (supposedly) tailored to the individual patient’s constitution and his or her life style featured quite prominently in many written medical consultations. The extant evidence suggests, however, that physicians elaborated such individualized dietetic advice primarily for a small group of upper-class patients. In ordinary medical practice, by contrast, regimens seem to have played only a marginal role: Physicians gave little advice and much medicine rather than the opposite. As to the gender and age of his patients, Finzel’s journal demonstrates a predominance of male patients. This is a familiar finding in the early modern period although the reasons remain unclear. More surprising is the remarkable number of infants and children in Finzel’s practice. Clearly, even the very young were not always left to their fate or entrusted to the care of midwives or ‘wise women’ or other lay practitioners. When it comes to the social status of the physician’s patients, finally, Finzel’s journal calls for nothing less than a substantial revision of long-held beliefs about the place and the role of learned medical practice in the sixteenth century. The aristocratic minority among Finzel’s patients was more likely to consult him on a regular basis and from some he even received a regular salary. However, the large total number of patients in Finzel’s practice, the modest fees of 1, 2 or 3 groschen per consultation most of them paid, and the numerous artisans and country-folks who sought his advice make it clear that Finzel’s services were accessible to and used, at one time or another, by large parts of the population. One of the principal, recurring provisions that we find in many town physicians’ contracts at the time was that they offered their services to rich and poor alike and without charging excessive fees.71 Finzel’s journal demonstrates that this provision was not just rhetorical—and that the town councils got what they wanted. And by paying them a salary that guaranteed a basic level of subsistence, they helped the physicians, in turn, to assume an increasingly important role in the health care of the population at large. Michael Stolberg is director of the Institute of the History of Medicine at the University of Würzburg, Germany. He has published widely on the history of early modern medicine and the body as well as on the history of medical ethics and palliative care. Drawing, in particular, on manuscript sources such as the personal notebooks and practice journals of medical students and physicians, his current work focuses on medical training and the world of ordinary medical practice in sixteenth-century Europe. Footnotes 1 On the figure of the early modern town physician see Andrew W. Russell, ed., The Town and State Physician in Europe from the Middle Ages to the Enlightenment (Wolfenbüttel: Herzog-August-Bibliothek, 1981); Ruth Schilling, Sabine Schlegelmilch and Susan Splinter, ‘Stadtarzt oder Arzt in der Stadt? Drei Ärzte der Frühen Neuzeit und ihr Verständnis des städtischen Amtes’, Medizinhistorisches Journal, 2011, 46, 99–133; there are numerous smaller and mostly older studies on individual town physicians and histories of town physicians in certain localities. See e.g. Werner Bubb, Das Stadtarztamt zu Basel. Seine Entwicklungsgeschichte vom Jahre 1529 bis zur Gegenwart. Diss. med. Basel (Zürich: Leemann, 1942); Karl Heinz Burmeister, ‘Die Lindauer Stadtärzte Dr. med. Johann Mürgel (1494–1561) und Dr. med. Abraham Mürgel (1524–1594)’, Jahrbuch des Landkreises Lindau, 2000, 15, 36–42; Oswald Feis, ‘Aus der Praxis eines spätmittelalterlichen Frankfurter Stadtarztes’, Sudhoffs Archiv, 1922–23, 14/15, 98–104; Karl Leuthardt, Das Stadtarztamt zu Basel; seine Entwicklungsgeschichte bis zum Jahre 1529. Diss. med. Basel 1940 (Zürich: Leeman,1940); Gerhard Naber, Der Arzt als städtischer Amtsträger im alten Amberg (Erlangen−Nürnberg: typescript diss. med. 1967); Hubert Patscheider, ‘Die Stadtärzte im alten St. Gallen’, Schriften des Vereins für Geschichte des Bodensees und seiner Umgebung, 1997, 115, 89–132; Yvonne Thurnheer, Die Stadtärzte und ihr Amt im alten Bern (Bern: Haupt, 1944). 2 For overviews see Laurence W. B. Brockliss and Colin Jones, The Medical World of Early Modern France (Oxford: Clarendon, 1997); Mary Lindemann, Medicine and Society in Early Modern Europe, 2nd edn (Cambridge: Cambridge University Press, 2010). 3 Harold J. Cook, ‘Good Advice and Little Medicine. The Professional Authority of Early Modern English Physicians’, Journal of British Studies, 1994, 33, 1–31. 4 Early examples are Antonio Benivieni, De abditis non nullis ac mirandis morborum et sanationum causis (Florence: Giunta, 1507); Amatus Lusitanus, Curationum medicinalium centuria prima, multiplici variaque rerum cognitione referta (Florence: Laurentius Torrentinus, 1551); François Valleriola, Observationum medicinalium libri sex (Lyon: Andrea Gryphius, 1573); Rembertus Dodonaeus, Medicinalium observationum exempla rara, recognita et aucta, 2nd edn (Cologne: Cholinus, 1581); on the growing importance of printed collections of medical observations as a literary genre see Michael Stolberg, ‘Formen und Funktionen ärztlicher Fallbeobachtungen in der Frühen Neuzeit (1500–1800)’, in J. Süßmann, S. Scholz and G. Engel, eds, Formen und Funktionen ärztlicher Fallbeobachtungen in der Frühen Neuzeit (1500–1800) (Berlin: trafo 2007), 81–95; Gianna Pomata, ‘Sharing Cases: The Observationes in Early Modern Medicine’, Early Science and Medicine, 2010, 15, 193–236. 5 As François Valleriola explained, for example, the 60 cases he published in 1573 were taken from more than 600 histories of ‘more serious’ cases in his own practice, suggesting that the number of patients he had actually treated was much higher (Valleriola, Observationum, 263). 6 Even in the case of Pieter van Foreest who published the largest collection of observations by far (Pieter van Foreest, Observationum et curationum medicinalium libri (Leiden: Plantin, 1590ff), we do not know how many of the cases he treated actually made it into his observations and to what degree he selected cases for publication, for example, because they highlighted his diagnostic acumen and his therapeutic skills. Brian Nance, Turquet de Mayerne as Baroque Physician. The Art of Medical Portraiture (Amsterdam/New York: Rodopi, 2001); for the nineteenth and twentieth centuries see Elisabeth Dietrich-Daum, Martin Dinges, Robert Jütte and Christine Roilo, Arztpraxen im Vergleich: 18.−20. Jahrhundert (Innsbruck: StudienVerlag, 2008). 7 Martin Dinges, Kay Peter Jankrift, Sabine Schlegelmilch and Michael Stolberg, eds, Medical Practice, 1600–1900. Physicians and Their Patients (Leiden: Brill, 2016). 8 Lauren Kassell, ‘Casebooks in Early Modern England: Medicine, Astrology, and Written Records’, Bulletin of the History of Medicine, 2014, 88, 595–625, esp. pp. 614–5. 9 URL: www.magicandmedicine.hps.cam.ac.uk/; see also Michael MacDonald, Mystical Bedlam: Madness, Anxiety, and Healing in Seventeenth-century England (Cambridge: Cambridge University Press, 1981), which draws on these casebooks; the most extensive collection that has survived from the early seventeenth century are the notes of Théodore Turquet de Mayerne (1573 − 1655); cf. Nance, Turquet. 10 For Palm see Stadtbibliothek Nürnberg, Ms. Cent. V, 10b; Germanisches Nationalmuseum, Nürnberg, Hs 100.822; cf. Klaus G. König, Der Nürnberger Stadtarzt Dr. Georg Palma (1543 − 1591) (Stuttgart: Gustav Fischer, 1961); for Magenbuch, see Universitätsbibliothek Heidelberg, Cpl 1895–1 (the original manuscript is in the Vatican library) and cf. Peter Assion and Joachim Telle, ‘Der Nürnberger Stadtarzt Johannes Magenbuch. Zu Leben und Werk eines Mediziners der Reformationszeit’, Sudhoffs Archiv, 1972, 56, 353–421. 11 Michael Stolberg, ‘Empiricism in Sixteenth-century Medical Practice. The Notebooks of Georg Handsch’, Early Science and Medicine, 2013, 18, 487–516; Stolberg, ‘Learning from the Common Folks. Academic Physicians and Medical Lay Culture in the Sixteenth Century’, Social History of Medicine, 2014, 27, 649–67. 12 Ratschulbibliothek (RSB) Zwickau, Ms. QQQQ1a, QQQQ1 and QQQQ1b; from April 1565 until February 1567 Finzel only recorded about 60 consultations and his journal entries were probably not complete. 13 Hiob Finzel, Wunderzeichen (Nürnberg: Johann vom Berg and Ulrich Neuber, 1556–62). The literature on Finzel’s Wunderzeichen is quite extensive. For good overviews see Heinz Schilling, ‘Job Fincel und die Zeichen der Endzeit’, in W. Brückner, ed., Volkserzählung und Reformation. Ein Handbuch zur Tradierung und Funktion von Erzählstoffen und Erzählliteratur im Protestantismus (Berlin: Erich Schmidt Verlag, 1974), 326–93; Björn Aewerdieck, Register zu den Wunderzeichenbüchern Job Fincels (Frankfurt am Main: Lang, 2010), 7–54 (introduction). 14 See the detailed biographical sketch in Aewerdieck, Register, 10–21, and the collection of extracts from the relevant biographical sources ibid., 277–85. 15 In contemporary sources Finzel figures as ‘Vinariensis’, i.e. ‘from Weimar’ (Johannes Ursinus, Epithalamion in nuptiis doctissimi viri Magistri Iobi Fincelij Vinariensis, et pudicae virginis, Susannae, filiae viri integerrimi Nicolai Stigelij, pridem pie defuncti (Jena: Rödinger, 1555; Karl Eduard Förstemann, ed., Album Academiae Vitebergensis: ab a. CH. MDII usque ad a. MDLX (Leipzig: Leipzig, 1841), 218, with Finzel’s immatriculation record in Wittenberg. In principle, this could also mean that he came from the area around Weimar but in his epicedion for his sister Finzel clearly refers to Weimar itself as her—and thus presumably also his own—native city (Hiob Finzel, Epicedion honestae puellae Annae Finceliae Vinariensis pie defunctae in Pomerania (Jena: Rödinger, 1556)). 16 Förstemann, Album, 218, ‘Hiob Funtzschel’; Adrian Beier, Syllabus rectorum, et professorum Jenae (Jena: typis Caspari Freyschmidii, 1659), 896 and 968. 17 Beier, Syllabus, 968. 18 For his published poetry, see Hiob Finzel, Elegia Tyrtaei poetae antiquissimi (Magdeburg: Lottherus, 1550); Finzel, ‘Epithalamium in nuptiis Doctissimi viri M. Davidis Chytraei’, in J. Stigel et al., Ioannis Stigelii elegia, qua celebratur dignitas et fructus legitimi coniugij, scripta in nuptijs doctissimi viri Davidis Chytraei professoris Academiae Rostochianae, et alia epithalamia scripta a Iobo Fincelio, Nicolao Cisnero, & Iohanne Willebrochio (Wittenberg: Iohannes Crato, 1553), no pagination; Finzel, ‘Ad illustrissimum principem ac dominem D. Ioannem Fridericum II. ducem Saxoniae’, in J. Stigel, In nuptiis illustrissimi Principis ac domini Joannis Friderici II. Ducis Saxoniae .^.^. et Agnae, natae Principis Hessorum, epithalamion. Accesserunt & aliorum carmina (Jena: Rödinger, 1555), no pagination; later, Finzel also edited the poems of his mentor, the theologian and poeta laureatus Johann Stigel, for whom he also wrote the funeral sermon (Finzel, Hiob, In obitum summi et clarissimi poetae Johannis Stigelii epicedion (Jena: Rebart, 1562). 19 Georg Agricola (1530 − 1574), for example, first served as rector of the school in Amberg for about 15 years and obtained his medical doctorate only about 16 years after his master’s degree (Naber, Arzt, 113). Some future physicians even first turned to theology. Jacob Degen aka Schegk, for example, first studied theology and was ordained as a priest and only then turned to medicine (Miriam Eberlein, ‘Die Medizinische Fakultät im späten 16. Jahrhundert’ in U. Köpf, S. Lorenz and D. R. Bauer, eds, Die Universität Tübingen zwischen Reformation und Dreißigjährigem Krieg. Festgabe für Dieter Mertens zum 70. Geburtstag (Osterfildern: Thorbecke, 2010), 249–98). 20 Ioannes Schroterus, Themata de peste. Praes. Ioanne Schrotero. Respondebit M. Iobus Fincelius (Jena: Rebart, 1562). 21 RSB Zwickau, Ms. QQQQ1a, 163. 22 At the time, there were three hospitals for the poor in Zwickau (Emil Herzog, Chronik der Kreisstadt Zwickau, II (Zwickau: Zückler, 1839), 330). 23 Stadtarchiv Zwickau, Sign. A A II, 11, Nr 12, 1r–2r, reproduced in Aewerdieck, Register, 277. 24 RSB Zwickau, Ms. QQQQ1a, 275 details Finzel’s start in Zwickau. 25 Staatsarchiv Coburg, LA A 10529, 125r–v, letter from Finzel to the captive Duke Johann Friedrich, Zwickau, 6 June 1572. 26 According to Herzog, Chronik, 319, Finzel died on 1 July 1589; Herzog probably still had access to the parish registers which are no longer extant; in December 1589, Finzel’s successor as town physician, Petrus Poach, received his first salary. Earlier dates like 1568 (Ernst Giese and Benno von Hagen, Geschichte der Medizinischen Fakultät der Friedrich-Schiller-Universität Jena (Jena: 1985), 125) or 1582 in the Wikipedia entry (https://en.wikipedia.org/wiki/Jobus_Fincelius, acccessed 28 April 2017) are proven wrong by his ongoing publications and by his journal. 27 The Ratschulbibliothek also holds a whole collection of Poach’s correpondence (Ratschulbibliothek Zwickau, Sign. J). 28 A good seventeenth-century example is the carefully drafted and beautifully illustrated collection of medical cases by Johann Frank in Ulm (Stadtarchiv Ulm, Mss Franc 8a and 8b). 29 For a detailed analysis of the economic aspects of Finzel’s practice and of his approach to accounting see Michael Stolberg, ‘Accounting in 16th-century Medical Practice: Hiob Finzel’s Rationarium praxeos medicae, 1565 − 1589’ (contribution to a forthcoming collective volume on the history of accounting and medicine, ed. by A. Hüntelmann and O. Falk). 30 In this respect Finzel’s journal resembles the (typically narrow, long) recipe journals that were often kept in the pharmacies at the time and into which the prescriptions of the physicians were entered. Some seventeenth-century examples are Germanisches Nationalmuseum Nürnberg, Historisches Archiv, Pharmaceutica, No. 3 (Ingolstätter), No. 14 (Blendinger) and No. 15 (Göckel). 31 Stolberg, ‘Empiricism’. 32 RSB Zwickau, Ms. QQQQ1a, 168 and 371; ibid., Ms. QQQQ1, 42. Finzel may have used a special notebook to record therapeutic effects and other observations. In his journal, he mentioned ‘my little book’ in which he had noted a patient’s symptoms and he also referenced ‘my diary’—which may have been the same—for the recipe of a decoctum magistrale; cf. RSB Zwickau, Ms. QQQQ1a, 373, ‘Accidentia sunt comprehensa in meo libello’; ibid., 145, ‘vide in diario meo’. 33 RSB Zwickau, Ms. QQQQ1a, 260; ibid., 265. 34 Notes on political events can be found at RSB Zwickau, Ms. QQQQ1a, 90, while the judgement of von Enda’s wife is at RSB Zwickau, Ms. QQQQ 1, 433, January 1577, ‘Ist inn dem Jar zur Huren worden’. 35 I gratefully acknowledge the invaluable assistance of Hannes Langrieger, who did much of this initial, laborious work of entering names and data into a computer. 36 My figures include 176 consultations that ended up on pages at the very end of the last volume, when the fascicles were bound, but which clearly refer to 1585 and end with Fincel’s calculation of his earnings in 1585. 37 There is some margin of error. On the one hand, Finzel may sometimes not have recorded every single consultation, when he saw a patient very often and was not paid for every single visit. On the other hand, entries which only indicate a name and a certain sum of money may sometimes not reflect an actual consultation but only a payment for previous consultations. Since many patients for whom he only recorded the name and the amount paid do not figure a second time in the journal, at least not without indicating another payment, we can safely assume, however, that even entries that consist only of name and payment usually reflect a consultation. 38 The precise figure is 614 consultations in 23 months (RSB Zwickau, Ms. QQQQ1a). 39 Stadtbibliothek Nürnberg, Ms. Cent. V, 10b. The precise figure is 929 consultations in 94 months; it is based on Palm’s own index to his journal which lists the patients’ names alphabetically with the various page numbers on which they appear. 40 In Ms QQQQ 1b, individual fascicles were bound in the wrong order, sometimes with certain pages missing, which have to be identified elsewhere, sometimes with a seemingly continuous pagination—e.g. a fascicle ending with fol. 6v, followed by one beginning with fol. 7r—but clear evidence (primarily from Finzel’s interim calculations of his earnings) that the fascicle actually belongs to a different year. My figures are based on what I take to correspond to the true chronological order but a smalll margin of error remains. 41 See e.g. Giovanni Battista da Monte, Consultationes medicae ([Basel: Waldkirch], 1583) on the tradition of the Padua school. 42 On Galenist medical practice see Andrew Wear, ‘Medicine in early modern Europe 1500–1700’, in I. C. Lawrence, M. Neve, V. Nutton, R. Porter and A. Wear, eds, The Western Medical Tradition, 800 BC to AD 1800 (Cambridge: Cambridge University Press, 1995), 215–361; Andrew Wear, Roger French and Iain Lonie, eds, The Medical Renaissance of the Sixteenth Century (Cambridge: Cambridge University Press, 1985); Andrew Wear, Knowledge and Practice in English Medicine, 1550 − 1680 (Cambridge: Cambridge University Press, 2000). 43 On the complex history (and historiography) of premodern hysteria see Helen King, ‘Hysteria Beyond Freud’ in S. L. Gilman, H. King, R. Porter, G.S . Rousseau and E. Showalter, eds, Once Upon a Text. Hysteria from Hippocrates (Berkeley: University of California Press, 1993), 3–90. 44 For the seventeenth century, see Katherine E. Williams, ‘Hysteria in Seventeenth-century Case Records and Unpublished Manuscripts’, History of Psychiatry, 1990, 1, 383–401. 45 In some cases Finzel explicitly diagnosed a praefocatio matricis ‘ex mensibus impeditis’, i.e. from a retention of the menses. 46 RSB Zwickau, Ms QQQQ1, 99. 47 See e.g. Montius, Pamphilus, Methodus medendi (Augsburg: Henricus Steynerus, 1540); Valles, Francisco, Methodus medendi (Venice: Georgius Angelerius, 1589); Riolan, Jean, Methodus generalis bene medendi: ad omnes morbos recta ratione curandos summe utilis et necessaria (Lyon: Faber, 1589). 48 RSB Zwickau, Ms QQQQ1a, 279 (1571). 49 For contemporary writing on pediatrics, see Sebastianus Austrius, De infantium sive puerorum morborum et symptomatorum dignitione tum curatione liber (Basel: apud Bartholomeum Westhemerum, 1540); Leonellus Faventinus de Victoriis, De aegritudinibus infantium tractatus admodum salutifer (Venice: Valgrisius, 1557); Omnibonus Ferrarius, De arte medica infantium quorum duo priores de tuenda eorum sanitate, posteriores de curandis morbis agunt (Brixen: de Marchettis, 1577); Girolamo Mercuriale, De morbis puerorum tractatus (Venice: apud Paulum Meietum, 1583). On obstetrics, see the highly successful collection of gynaecological texts in Kaspar Wolf, ed., Gynaeciorum, hoc est, de mulierum tum communibus, tum aliis, tum gravidarum, parientium, et puerperarum affectibus et morbis libri (Basel: Thomas Guarinus, 1566), with further editions in 1586 and 1597; cf. Helen King, Midwifery, Obstetrics and the Rise of Gynaecology. The Uses of a Sixteenth-century Compendium (Aldershot: Ashgate, 2007); Monica Green, Making Women’s Medicine Masculine. The Rise of Male Authority in Pre-modern Gynecology (Oxford: Oxford University Press, 2008). 50 E.g. Roy Porter and Dorothy Porter, Patient’s Progress. Doctors and Doctoring in Eighteenth-century England (Cambridge: Polity Press, 1989), 183. 51 Stadtbibliothek Nürnberg, Ms. Cent. V, 10b, based on Palm’s own index to his journal which lists the patients’ names alphabetically; Franziska Ofenhitzer, Praxisalltag in der Frühen Neuzeit. Das Rezeptdiarium (1612–1616) von Petrus Kirstenius aus Breslau (Würzburg: typescript med. diss., 2015), 92. 52 In addition to those referring generically to ‘infants’ and ‘children’, ten further entries do not reveal the gender of the patient. 53 Ofenhitzer, Praxisalltag, 91. 54 This includes noblewomen; see Alisha Rankin, Panaceia’s daughters. Noblewomen as Healers in Early Modern Germany (Chicago and London: University of Chicago Press, 2013). 55 Presumably, when Finzel recorded no place of residence, the patient was from Zwickau or, before he moved there, from Weimar or Eisenach. 56 Nicholas D. Jewson, ‘Medical Knowledge and the Patronage System in 18th Century England’, Sociology, 1974, 8, 369–85. 57 See, e.g., the various contributions in Dinges et al., Medical Practice. 58 Helmut Bräuer, Wider den Rat. Der Zwickauer Konflikt 1516/17 (Leipzig: Leipziger Universitätsverlag, 1999), 34 estimates the population to have been around 7,300 in 1530; Hildegard Berthold, Karl Hahn and Alfred Schultze, eds, Die Zwickauer Stadtrechtsreformation 1539/69 (Leipzig: Hirzel: 1935), 2, arrive at 7,677 inhabitants in the mid-sixteenth century. 59 Günter Grosche, Zwickauer Ärzte und Apotheker im 16. Jahrhundert (Zwickau: unpublished typescript, 2000 = Stadtarchiv Zwickau, Sign. I M 512), 7–8. Moreover, from 1577 to 1587, we find Andreas Schultheiß from Prenzlau. He was also a pharmacist, however, and it remains unclear whether he actually treated patients. Grosche concluded from his thorough acquaintance with the local archives that, in sixteenth-century Zwickau, usually three to four physicians were active at the same time (ibid., 9); see also Anett Drechsel, Das Gesundheitswesen der Stadt Zwickau von den Anfängen bis zum Ausgang des 17. Jahrhundert (Leipzig: typescript medical dissertation, 2003). 60 Finzel seems to have indicated quite consistently when patients came from noble families. Nevertheless his records are sometimes not entirely clear. An entry on a ‘Frau von Auerbach’, for example, may have referred to a woman coming from the town of Auerbach—or to a member of the noble family of that name. 61 Since Finzel frequently only gave the name or the profession and did not always use Latin terms, there is some uncertainty especially in the case of professions which were also common names, such as blacksmiths (‘faber ferrarius’ but also ‘Schmid’), tailors (‘sutor’, ‘sartor’ but also ‘Schneider’) and bakers (‘pannifex’ but also ‘Beck’): we cannot always be sure that a patient identified e.g. as ‘Schneider’ was a tailor (in German ‘Schneider’) or just went by that name. 62 Twelve patients were identified as strangers or travellers (‘peregrinus’). 63 Sabine Schlegelmilch has come to the same conclusion for Johannes Magirus who practised around 1650 in Zerbst (Ruth Schilling, Sabine Schlegelmilch and Susan Splinter, ‘Stadtarzt oder Arzt in der Stadt? Drei Ärzte der Frühen Neuzeit und ihr Verständnis des städtischen Amtes’, Medizinhistorisches Journal, 2011, 46, 99–133), 107. 64 Finzel got a whole gold piece (‘Goltgulden’), for example, for treating the servant (‘Knecht’) of Jörg Marschall (RSB Zwickau, Ms. QQQQ1a, 47). 65 Heinz Voigtlaender, Löhne und Preise in vier Jahrtausenden (Speyer: Numismatische Gesellschaft Speyer, 1994). 66 Stadtbibliothek Nürnberg, Ms. Cent. V, 10b; figures based on Palm’s index, with the different pages on which entries on one and the same patient could be found. 67 Schilling, Schlegelmilch and Splinter, ‘Stadtarzt’, 107. 68 RSB Zwickau, Ms. QQQQ1a, 58, ‘Tannroda, duae urinae’; ibid., 332, ‘Urin von Glauchaw’. On the outstanding importance of uroscopic diagnosis at the time, see Michael Stolberg, Uroscopy in Early Modern Europe (Farnham: Ashgate, 2015). 69 On von Weisbach, see RSB Zwickau, Ms. QQQQ1a, 385, ‘halb Jar Besoldung’; ibid., Ms. QQQQ1, 39; on Albrecht, see RSB Zwickau, Ms. QQQQ1a, 42, ‘Jar Besoldung’; on von Enda, see RSB Zwickau, Ms. QQQQ1, 39 ‘halbe Jar Besoldung’. 70 Sandra Cavallo and Tessa Storey, Healthy Living in Late Renaissance Italy (Oxford: Oxford University Press, 2014); David Gentilcore, Food and Health in Early Modern Europe. Diet, Medicine and Society, 1450 − 1800 (London: Bloomsbury Academic, 2016). 71 See the Würzburg database on early modern physicians’ letters which also includes such contracts, as addressed to individual physicians or confirmed by them (www.aerztebriefe.de). © The Author 2017. Published by Oxford University Press on behalf of the Society for the Social History of Medicine. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Social History of Medicine Oxford University Press

A Sixteenth-century Physician and His Patients: The Practice Journal of Hiob Finzel, 1565–1589

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© The Author 2017. Published by Oxford University Press on behalf of the Society for the Social History of Medicine.
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Abstract

Summary This paper presents the results of a detailed analysis of the most extensive practice journal by far that is known to have survived from any medical doctor in sixteenth-century Europe. Over a period of almost 25 years, Hiob Finzel, town physician first in Weimar and later, for most of his professional life, in Zwickau recorded more than 10,000 consultations. Looking at the age and gender of his patients in Zwickau, we find a predominance of male patients and a remarkable number of infants and children. While only a minority of (mostly upper-class) patients consulted Finzel regularly, an analysis of the patient’s professions (viz. that of the respective bread-winner) and the very moderate fees they paid shows that Finzel’s services were accessible to and called for not just by a small urban elite but by large parts of the population, including many artisans and country folk. medical practice, practice journal, town physicians, patients, Hiob Finzel Introduction Learned physicians played a growing role in sixteenth-century society and health care. Not only were they able, based on their thorough training in the liberal arts and in natural philosophy, to establish themselves as a major group within the res publica litteraria; they also found increasing recognition as medical practitioners. German and Swiss town magistrates, by the 1550s, almost routinely preferred their services to those of a non-academic barber-surgeon when they appointed a medical practitioner as Stadtarzt.1 Contemporary autobiographies and personal correspondences indicate that on the European continent, at least among the urban upper classes and the nobility, physicians enjoyed considerable trust and frequently were the first choice when someone in the family got sick.2 While the scholarly activities of sixteenth-century physicians and their extensive participation in epistolary networks are well documented, rather little is known about ordinary learned medical practice and the average physician’s day-by-day activities. Who consulted an academic physician rather than a barber surgeon or another less learned practitioner? Did learned physicians, as historians have claimed for a long time, cater almost exclusively to the rich and mighty? Or did they treat patients from many walks of society, as others have more recently suggested? For what kinds of complaints or diseases were they consulted? What could they offer? Is it true that physicians, as Hal Cook has argued for early modern England, gave ‘much advice and little medicine’?3 Last but not least, how did physicians fare economically? To what degree could they make a living from their medical practice? Unfortunately, sources that reflect physicians’ actual practice—rather than general, theoretical ideas about medicine and different diseases—are very limited. Among printed sources, collections of curationes and observationes offer valuable information about the ways in which individual physicians diagnosed and treated patients and, to some degree, about the patients who consulted them.4 Most of these collections can be taken to reflect ordinary learned medical practice only to a rather limited degree, however. Their authors were almost inevitably very successful or indeed famous physicians—otherwise, they would have found it difficult to publish their observationes. Even more importantly, most of them selected, from the many patients they had seen, a certain number—and sometimes a very small number indeed—of particularly revealing, interesting or ‘rare’ cases for publication.5 In making their choices, they were inevitably also guided by their desire to highlight their personal diagnostic and therapeutic skills and the high social standing of the patients who sought their advice. A much more reliable guide and indeed the best source, by far, for the ordinary practice of learned physicians in that period and for the patients who consulted them are practice journals. Probably many early modern physicians kept such journals, in which they recorded, day by day, the patients they saw, adding varying amounts of further information: the patients’ complaints, the diagnosis, the medicines they recommended, the payment they received, the patients’ profession, age, sex, place of residence. Because of the wealth of data that can be gleaned from practice journals, they have attracted growing attention over the last few years.6 Only recently, the major results of the collaborative work of a total of eight research groups of a German-Austrian-Swiss research network on medical practices from the seventeenth to the late nineteenth century have been published, with each group taking a practice journal (or a collection of practice journals) as the starting point.7 For the time before 1600, the situation is particularly difficult, in terms of identifying suitable sources. Lauren Kassell’s survey of early modern medical case books in England has shown that very few manuscripts from ordinary, orthodox physicians have survived from this early period that can be described, at least in a wider sense, as casebooks—basically there are only a couple of remedy lists that also indicate the patients’ names and the miscellaneous notes of a Hampshire physician that include some cases.8 Kassell also directs the Cambridge Casebook Project, which is in the process of putting the casebooks of Simon Forman and Richard Napier online, by far the most extensive casebooks that have so far been identified for the sixteenth and early seventeenth centuries and a fascinating source. However, although Forman and Napier, being learned men, may well have been taken for ‘doctors’ by many of their patients, they were not trained physicians and theirs was primarily an astrological practice.9 Sources are similarly rare for learned physicians on the European continent. For sixteenth-century Germany, the only notable exceptions that have so far been made known are two journals by Georg Palm, which are largely limited to listing the recipes he prescribed, and some fragments, covering only several months, of that of Johann Magenbuch, both physicians in Nuremberg.10 The extensive notes that the Bohemian physician Georg Handsch took on the patients that he and his colleagues saw and treated in and around mid-sixteenth-century Prague and later in Innsbruck offer many new insights into the doctor–patient relationship and the mutual exchange of medical knowledge between doctors and patients at the time. However, Handsch only recorded the cases of those patients—sometimes in day-by-day accounts—which he deemed in some way particularly noteworthy.11 In light of all this, the principal source on which this paper will draw is unique: three heavy folio volumes in which the German town physician Hiob Finzel recorded more than 10,000 consultations over a period of almost 25 years, from 1565 to 1589.12 Until now totally overlooked by historians, this is by far the most extensive and complete known record of the practice of any individual learned physician in sixteenth-century Europe. The source is all the more valuable because there is little to indicate that Finzel’s medical practice was exceptional or untypical. Finzel—or Iobus Fincelius as he usually called himself in writing—is a well-known figure among historians of German literature and popular culture. He was the author of the Wunderzeichen, a wide-ranging collection of accounts of portents, miracles and other spectacular events, that Finzel, a devout protestant, presented as divine admonitions that humankind must change its ways.13 This work predates Finzel’s move into medicine, however, and there is nothing to suggest that his later situation and work as a town physician in medium-sized towns like Weimar and Zwickau differed substantially from that of many other learned town physicians at the time. My analysis will start with a biographical sketch and will proceed to present Finzel’s practice journal as my principal source. The bulk of this paper will then be devoted to a quantitative and qualitative analysis of Finzel’s entries, looking at the kinds of patients who sought his advice, their profession or social status, their age and sex and their medical conditions, and at their relationship with the learned physician. Hiob Finzel Interest in Finzel as the author of the Wunderzeichen has led historians to look for sources on his biography, but very little was known so far about his later years, when he worked as a medical practitioner.14 His journal and some newly found letters also throw new light on this part of his life. Hiob Finzel was born, probably around 1526, in Weimar.15 He studied the liberal arts in Wittenberg and graduated there in 1549.16 From 1549, we find him lecturing on natural history in the Gymnasium academicum in Jena, where he served as a professor once the Gymnasium became a university in 1558.17 During this period, Finzel sought to establish himself as a humanist scholar and poet. He translated the elegies of the Greek poet Tyrtaios and published various poems of his own, and he worked on his Wunderzeichen.18 By the time the last part of the Wunderzeichen came out, Finzel had already turned to medicine, however. Such a relatively late turn towards medicine was not uncommon at the time, especially among scholars who began lecturing in the arts faculty once they had obtained a master’s degree.19 In Finzel’s case—and the same is presumably true for other physicians—this decision probably reflected the greater degree of economic security that learned physicians tended to enjoy, compared to scholars well versed in the studia humanitatis but without a particular professional training. In December 1562, Finzel received his medical doctorate in Jena, defending a thesis on the plague.20 In the spring of 1564, he was appointed as a town physician in Weimar for three years. When his contract was not renewed in 1567, he worked for some time in private practice and, from 1569 until 1571 as a court physician in Eisenach.21 Finally, in April 1571, he was appointed as a town physician in Zwickau. His contract obliged him to serve the town and its citizens, to perform an annual visitation of the local pharmacies and to advise the sick in the hospitals and sick-houses out of ‘Christian charity’, that is, presumably for free.22 Like many of his colleagues in other towns, he was not allowed to leave the town over night without the mayor’s permission.23 Finzel began working in Zwickau in July 1571 and he was to remain there for the rest of his life.24 Finzel had found his place, as a pater familias with a growing family, as well as professionally and economically. Zwickau was a fairly prosperous town with a strong tradition in cloth production and some sizeable mining activities in the area. In a letter to the captive Duke Johann Friedrich of Saxony—whose wife and children he had cared for in Eisenach—he wrote in June 1572 that he had never had such a ‘stately’ practice.25 Finzel’s Practice Journal The entries in Finzel’s practice journal start in April 1565 when he was still a town physician in Weimar, and they end shortly before his death, in 1589.26 Finzel did not use an album, a book with empty pages, for his journal but wrote on little fascicles or individual sheets of paper. There are no empty pages at the end of any of the three volumes and they have an (almost) identical binding. This, occasional mistakes in the chronological order of the fascicles and the fact that the notes extend until shortly before his death, strongly suggests that they were bound in three folio volumes only after his death. We do not know how the manuscript came into the possession of the Ratschulbibliothek. The most likely explanation would seem to be that another physician—maybe Peter Poach, Finzel’s successor in Zwickau—considered these notes as potentially useful and had them bound, and that they were later given to or acquired by the Ratschulbibliothek.27 During the first couple of years, the entries in Finzel’s journal are dated only sporadically. From 1572, Finzel marked the beginning of every new year and indicated the respective month on the top of each page. It is because of this strictly chronological organisation that I use the term ‘practice journal’ here rather than the well-established but more generic term ‘casebook’. A practice journal—certainly one like Finzel’s that is not limited to just listing names and dates but also gives information on the individual cases—is a casebook. However, not every casebook is also a practice journal: the term ‘casebook’ can refer to any collection of medical cases or case histories, including heavily selected ones and collections in which cases are not sorted chronologically but according to diseases or body sites.28 As a rule, each entry in Finzel’s casebook seems to have corresponded to a single consultation. Even when patients consulted him only a couple of days later, Finzel made a new entry, and occasionally two entries on the same patient follow one right after the other, with headings like ‘idem’ or ‘dieselbe’ (‘the same’). The length of the various entries and the amount of information Finzel recorded vary considerably (see Figure 1). A complete entry comprises: (1) the name of the patient viz., in the case of wives, children or servants, usually that of the husband, father or employer, (2) the bread-winner’s profession or, in the case of noble patients, the title or military rank, (3) the place of residence, (4) the diagnosis, (5) the medicines Finzel prescribed, and (6) the payment he received. Fig. 1. View largeDownload slide Double-page from Finzel’s practice journal, September 1573 (RSB Zwickau, Ms. QQQQ1, 62–63) Fig. 1. View largeDownload slide Double-page from Finzel’s practice journal, September 1573 (RSB Zwickau, Ms. QQQQ1, 62–63) In only a minority of the entries, did Finzel provide information on all six points, however. Numerous entries are limited to some kind of identifying information (name, profession, or place of residence, or indeed just ‘rusticus’ or ‘man’), the medicines given and the payment received. From this, the two principal functions of Finzel’s journal can readily be recognised. First, it was an account book. In fact, the journal was archived among the manuscripts of the Ratschulbibliothek under the title Rationarium, that is, ‘account book’, and this may be a major reason why historians have overlooked it. Even when he recorded no other information on a certain patient, Finzel usually indicated the payment he received for his services, and he used these entries to calculate his annual earnings at the end of each year.29 The second major function of Finzel’s patient journal was to record his diagnosis and his prescriptions and sometimes, but much more rarely, the indicationes curativae, that is, the reasons why he chose particular medicines and what effect he hoped to achieve with them. The recipes of his prescriptions constitute the bulk of most entries. While Finzel rarely recorded dietetic recommendations—leave alone a detailed regimen—he relied heavily on medicines. Presumably, he copied the recipes, which had to be taken to the pharmacy, into his journal. The recipes (see Figure 1) began with the familiar sign for recipe and listed (in Latin) the various ingredients with their respective quantities and concluded with the (German) term with which the pharmacist was to label it, such as ‘Hertzwasser’ (‘cordial’). Here, the journal served primarily as a mnemonic tool: if a patient consulted Finzel again, in the course of the same disease or when he or she later came down with another disease, Finzel could easily find out what he had told the patient and which medicines he had prescribed.30 The journal’s mnemonic function is underlined by about 130 entries on Finzel’s treatment of diseases in his family and of his own diseases, for which obviously no payment is recorded. A third major potential use of early modern patient journals was to improve diagnostic skills and/or therapeutic outcomes by assessing, retrospectively, whether the physician’s diagnosis and prognosis had proved correct and how well the medicines had worked. This is a function that patient journals have in common with the less systematic, casuistic notes in the notebooks of some other sixteenth-century physicians such as those of Georg Handsch.31 In Finzel’s journal, by contrast, this use played only a marginal role. He rarely documented the effect of his treatment. When he did it was mostly to note how well the laxatives he frequently prescribed had worked in the individual case (‘12 stools on the first day’, ‘8 sedes’) or that a patient had found the laxative to be ‘too strong’.32 Finzel’s practice journal also had very little in common with a personal diary. Only a couple of times did he note important personal events, such as his move from one place to another or the birth of one of his children.33 Notes on political events such as the conflicts between the French king and the Prince of Conde are likewise rare exceptions, as is the harsh moral judgement on the wife of one of his most prominent patients, Heinrich von Enda: ‘She turned into a whore this year’.34 Finzel’s Patients For the purpose of quantitative analysis, all entries in the three volumes of Finzel’s practice journal were entered into a tabular database.35 In what follows, my analysis will focus on the time period from January 1572 until December 1588, a few months before his death, the major and rather stable period in Finzel’s professional life as a physician.36 When we look at the numbers, an important distinction between two different sets of data must be kept in mind, namely that between figures referring to the total number of consultations and those referring to the number of individual patients. Since Finzel saw many patients more than once, the number of individual patients is considerably smaller than that of the consultations. In the 17 years from 1572 to 1588, Finzel recorded a total of 8,746 consultations, not including about 130 entries that referred to himself and his family.37 This means, on average, 516 consultations per year (see Figure 2). With 681 consultations in 1572, not even a year after his arrival in Zwickau, and 790 consultations in 1573, he could already boast a highly successful practice. In Weimar, he had only recorded about 320 consultations per year.38 Georg Palm, in Nuremberg, recorded an average of 118 consultations per year, from 1583 until 1591.39 Finzel clearly did not experience any initial difficulties in gaining a reputation and attracting patients, which were described, at the time, as virtually the inevitable fate awaiting a physician who set up a practice in a new locality. The relative lack of competition, his trust-inspiring age—he was already in his forties—and, above all, his good social connections − he had married the daughter of the mayor of Zwickau, Wolfgang Mühlpfort—probably played a major part in this success. Fig. 2. View largeDownload slide Annual number of consultations in Hiob Finzel’s Zwickau practice (1572–1588) Fig. 2. View largeDownload slide Annual number of consultations in Hiob Finzel’s Zwickau practice (1572–1588) Beginning in the late 1570s, we find a decline in the annual number of consultations, gradual at first and then, from 1585, quite significant (Figure 2).40 In economic terms, this decline was offset to some degree by higher fees, however. Since we have no evidence of increased local competition or health problems on Finzel’s part, the reasons remain unclear. Complaints and diagnoses In about 4,000 of his entries, Finzel recorded the diagnosis. Sometimes the diagnosis reveals, at least indirectly, which complaints led the patients to seek his advice. In about 500 entries, the primary diagnosis was some kind of fever. At the time, ‘fever’ was not synonymous with an increased temperature and physicians distinguished different types of fever, such as tertian, quartan or putrid fever, but ‘fevers’ were commonly associated with feeling hot and a general sense of weakness. About 80 times Finzel recorded pain, especially headaches, around 70 times dropsy, around 50 times bladder- or kidney-stones, around 40 times pleurisy, around 35 times coughing and around 20 times each epilepsy, jaundice and asthma. Only 10 patients were diagnosed with podagra or gout, a disease which has widely—and thus possibly wrongly—been taken to be the quintessential sickness of the age. In most cases, Finzel’s diagnosis does not reveal the actual symptoms or complaints, however, that had prompted the patients to seek his help. Like many other learned physicians of the time—this was, for example, what medical teaching in Padua in the tradition of Giovanni Battista da Monte was famous for—he sought to identify the pathological processes inside the body, which he considered, in turn, responsible for the patient’s complaints and for the changes that could be observed from the outside.41 As was typical for a Galenist physician of his time, the diagnostic terms that he used for the large majority of patients circled around notions of impure, corrupt matter and around the processes that led to its production and accumulation, on one hand, and its insufficient movement to and excretion through the natural pathways, on the other.42 On roughly 500 occasions, he recorded a cruditas as the major problem, that is, crude, corrupt humours, which accumulated in the body or in certain parts. Within the Galenic system, such crude humours could result, in particular, from an insufficient ‘concoction’ of food, which was due, in turn, above all to a weak or cold stomach, a diagnosis Finzel reached in another 120 entries. About 160 times he found an ‘obstruction’ or ‘oppilation’, mostly in the mesenteric vessels or in the liver. More than a 100 times he diagnosed a ‘catarrh’. The term is still familiar today but it had a different meaning in Finzel’s time: it referred to any disease the physician attributed to fluid morbid matter that originated from the head or brain. Sometimes the morbid matter might flow down into the nose or into the trachea and the lungs, causing coughing and sneezing, thus roughly matching our modern understanding. Frequently the morbid matter settled in other parts of the body, however. Finzel diagnosed patients with a ‘catarrh’ towards an arm, a foot, to the pelvic bones or the back or even declared a ‘catarrh’ to be the cause of a paralysis. The most common diagnosis by far was reserved for women—and it is a rather surprising one: praefocatio or suffocatio matricis, the suffocation of the womb. In more than a thousand entries, this was Finzel’s principal diagnosis. Medical historians have taken the ‘suffocation of the womb’ to be largely synonymous with ‘hysteria’ or ‘hysterical symptoms’—which Finzel diagnosed in another 100 cases (and sometimes in combination with a ‘suffocation of the womb’).43 More research on the precise meaning of these terms is needed, based in particular on practice notes and other casuistic sources.44 It seems extremely unlikely, however, that so many of Finzel’s female patients complained of the attacks of shortness of breath caused by an ascending uterus to which the term ‘suffocation of the womb’ was usually taken to refer. A look at the etymology may be more helpful here: The term ‘hysterical’ is derived from the Greek word for the uterus. A humanist physician like Finzel, well versed in Greek, may thus simply have used the expression ‘hysterical symptoms’ to refer to all those whose origin he located in the uterus. Along similar lines, Finzel presumably used the term ‘suffocation of the womb’ in a much wider sense, namely as a generic term for the manifold effects of harmful vapours which were taken to arise from the uterus, when menstrual blood or the seed (which Galenic physicians also ascribed to women) corrupted or putrefied in the uterus, due to a retention of the menses or an insufficient evacuation of seed, for example in virgins and widows.45 Vapours or fumes were a very important and familiar concept in early modern learned medicine. Depending on their movement in the body, they could be responsible for a wide range of symptoms. They could cause pain in certain areas, like the pain in the mouth of the stomach, which Finzel, in Frau von Auerswald, attributed to ‘a consensus with the uterus and fumes ascending from it’.46 Finzel’s prescriptions and the countless medicines he used deserve a closer analysis in their own right. Like most physicians at the time, he based his treatment primarily on medicinal plants, which he mixed in certain quantities to produce the desired effect on the body. Often he only prescribed one (composite) remedy but frequently he also wrote, during a single consultation, different recipes for the same patient. The precise rationale behind his prescriptions frequently remains unclear but the German terms used to label them and his occasional notes on the indicationes curativae that guided his prescriptions indicate that Finzel’s therapeutic approach was generally in line with the principles of the Galenist methodus medendi as it was taught in the leading universities of the time.47 In order to achieve a true, ‘radical’ cure, a cure, that is, that fought the disease at its very roots, the physician had to identify the nature, source and location of the morbid matter in question, eliminate it and fight the underlying cause, for example an ‘obstruction’. The rationale underlying the physician’s diagnosis and treatment could be quite complex. When Dorothea von Schönberg, for example, suffered, amongst other problems, from severe coughing and putrid sputum and sometimes coughed up blood, he suspected a pulmonary ulcer. Finzel assumed that the morbid and, in this case, sharp aggressive matter flowed down into the lungs from the brain. From this he took his indicationes curativae: he sought, above all, to change the nature of the morbid matter in the brain itself, by making it milder and promoting its concoctio, to support its evacuation through the mouth and the nose by means of medicines the patient had to chew viz. put into her nose, to divert the flow of the matter away from the lungs towards the arm by means of a vesicatory and to prevent the production of further matter by remedies that dried the brain.48 The overwhelming majority of Finzel’s patients suffered from complaints that, according to Finzel’s diagnosis, reflected pathological processes deep inside the body. Such diseases, which had to be treated in turn by giving medicines that acted inside the body, were the privileged domain of the learned physician. ‘External’ diseases, by contrast, which were, at the time, considered the realm of surgery only, played a minor role in Finzel’s practice. Presumably, the patients preferred the advice of a barber surgeon in such cases. Finzel recorded four cases of hernia. A girl in the hospital had a large ulcer and a fistula on her leg. Two patients had suffered ‘injuries’. Somewhat more frequently, patients with morbid skin changes sought his advice. Finzel diagnosed about 20 patients as scabiosi and a dozen patients, including two women, as suffering from the French disease (‘morbus gallicus’, ‘morbus syphilis’). Due to their superficial, external manifestation, skin changes were usually considered the domain of surgery but their ultimate causes were frequently located in the body: the skin changes were taken to reflect the body’s attempt to eliminate some kind of morbid matter through pustules, rashes, ulcers and the like and they would only stop when the source of the morbid matter was eradicated—which was the physician’s task. Obstetrics—like pediatrics—attracted growing attention in learned medical writing at the time.49 Finzel was rarely consulted for health issues associated with pregnancy, birth and childbed but his journal indicates that the learned physician was certainly well advised to acquire some knowledge in that area as well. Three of his consultations were for a ‘difficult birth’ (difficilis partus)—two of them, in two consecutive years, for the Frau von Planitz, one of the foremost noble families in the area. Several women sought his advice for postpartum conditions such as a placenta that had partially remained in the body or for feeling hot (or feverish) due to an insufficient excretion of the lochiae (calor ex retento sanguine tempore partus). Age When we look at the age of Finzel’s patients, an initial remarkable finding is the considerable number of very young patients in Finzel’s practice. Historians have widely assumed that learned physicians in the early modern period rarely treated infants and children.50 Finzel’s journal ultimately confirms this finding but yields a more nuanced picture. Finzel recorded 94 consultations for an infant and 78 for a child (‘Kindelein’, ‘Kind’). In addition, there are 35 entries which refer to a ‘little son’ (‘filiolus’, ‘Söhnchen’) and 64 for ‘little daughter’ (‘filiola’, ‘Töchterlein’, ‘Megdlein’), an epithet Finzel used with his own daughters until they were about ten. When we add these entries, we arrive at a minimum of 271 consultations for infants and smaller children. Their number may well have been higher: Finzel recorded a further 83 consultations for ‘boys’ (‘pueri’) and 272 for ‘girls’ (‘puellae’), although some of the latter suffered from menstrual disorders and were thus at least in puberty. Moreover, other entries, which only give a name or recorded a patient as someone else’s son or daughter, may also have referred to children. We have no reliable data on the proportion of children among the general population but, compared to the total of 8,746 consultations, infants and children were by all appearances massively underrepresented in Finzel’s practice. Yet even the relatively small number of those whom Finzel explicitly described as infants and small children demonstrates that parents sometimes did seek the help of a learned physician for the very young—and that the physician needed the appropriate skills. This is confirmed by other sources. As Franziska Ofenhitzer has shown in her analysis of the prescription diary of Petrus Kirstenius in Breslau (October 1612 to December 1616), for example, about 18.5 per cent of the patients for whom he wrote a prescription were children.51 Consulting a learned physician for children’s diseases was somewhat more common among the upper classes but it was not limited to them. A total of 36 out of 94 consultations concerned infants from noble families but Finzel also recorded consultations for the infants of a baker, a barber, a barber surgeon, of several rustici and for about a dozen infants who are only identified by their hometown or village, which suggests that they did not come from well-known, prominent families either. Five consultations were for the infants of pastors and these highlight that churchmen, like everyone else, were not necessarily willing to trust only in God even with such very young patients. Gender Among the 8,564 consultations for patients whose gender can be identified male patients predominate with 4,863 consultations (56.6 per cent) against those of women (3,701 or 43.4 per cent).52 This was not unusual. In Palm’s practice, the proportion of men was even higher, with 63.4 per cent men versus 36.6 per cent women, and Ofenhitzer’s analysis of Petrus Kirstenius’ prescription diary in early seventeenth-century Breslau, leads to a ratio of 70.7 per cent to 29.3 per cent (Figure 3).53 Fig. 3. View largeDownload slide Proportion of female and male patients in physicians' medical practices Fig. 3. View largeDownload slide Proportion of female and male patients in physicians' medical practices The reasons are unclear. It seems unlikely that men were sick more frequently or more seriously than women. Neither is there much evidence that the health of men was generally perceived as more important than that of women, although this remains a possibility. Most likely, women more often than men preferred a non-academic healer and, in particular, a female one to a learned physician, and they may also have resorted more frequently to domestic remedies.54 Social status The figures given above referred to the number of consultations. When it comes to social status in particular, it is crucial, however, that we also establish the number of individual patients: patients from certain social groups may have sought a physician’s advice more frequently than others. I have therefore assigned a single patient-ID to entries on different consultations that clearly or at least very likely referred to the same patient. This process is inevitably fraught with a considerable margin of error. On the one hand, Finzel did not always record a specific patient the same way—or even write his or her name in the same manner. On the other hand, two different patients may be taken for one, because Finzel sometimes only wrote the last name of a patient (or of the patient’s husband or father), such as ‘Cuntz’ or ‘Lowasser’ or ‘Tobrissen’s wife’ or only the profession and place of residence, such as ‘baker in Berndorf’. Obviously, there may have been more than one Cuntz, Lowasser or Tobrissen in the area and more than one baker in Berndorf.55 Fortunately, the total number of patients in Finzel’s journal is quite large and most of them are identified very clearly, which reduces the effects of individual errors on the validity of my general conclusions. Within these methodological limitations, we arrive at a total of 6,551 different patients who sought Finzel’s advice over a period of 17 years. This figure already represents a striking finding in itself. For a long time, historians have assumed that learned physicians in the early modern period treated only a small minority of upper-class patients who sought their advice and could afford to pay for it.56 More recently, some historians have suggested that learned physicians, already by the sixteenth century may have appealed to a much wider segment of the population.57 Finzel’s journal offers, for the first time, precise data that substantiates this claim. Zwickau was a medium-sized town with not even 10,000 inhabitants.58 Even though Finzel also treated many patients from the surrounding locations with an unknown population, the sheer number of more than 6,000 different patients indicates that considerable parts of the population—and not only the rich elite—at one point or another asked Finzel for advice. What is more, Finzel was not the only learned physician in Zwickau. The data is scant but a systematic survey of contemporary lists of house- and land-owners in Zwickau reveals that Eusebius Wildeck, Finzel’s predecessor as a town physician still lived there—and presumably practised—at least until 1577. From 1580, Christoff Sehling is documented; he came as a young physician from the nearby mining town of Schneeberg; eventually even serving as mayor of Zwickau, from 1587 until 1595.59 If Finzel alone treated more than 6,000 different patients over the course of 17 years, there can be no doubt that large parts of the population, at one time or another, sought the advice of a learned physician. This conclusion is corroborated by the many entries that include references to the patient’s status or profession or in the case of women and children to that of the male bread-winner. As many as 511 patients or close to 8 per cent came from noble families—but more than 92 per cent did not.60 For around 3,000 of these remaining patients Finzel recorded the profession of the patient (viz. that of the husband, father or, more rarely, employer) or other indicators of social status and economic background. Among them, we find mayors, members of towns councils and administrative officers and we find the literate elite: teachers and, above all, about 170 patients from the households of pastors. A group of 50 patients were identified in generic terms as being (or belonging to the family of) a ‘citizen’ (‘civis’). We also find hundreds of more ordinary people, however. Dozens of patients were or came from the families of artisans and journeymen with professions such as tanners (10), shoemakers (6), millers (19), butchers (18), fishermen (5), coachmen (9), black-, hoof- and nail-smiths (25), potters (20), tailors (16).61 Others worked as innkeepers (17), bookbinders (1), bee keepers (2), messengers (2), gun makers (1), hangmen (1), scissor sharpeners (2), fiddlers and organ players (11), organ makers (4), glassmakers (1), goldsmiths (5), coppersmiths (1), nail smiths (1), paper makers (5), cooks (4), candle makers (1), cowherds (2) or fur makers (5). A small number, 23, are recorded as ‘poor’ or as hospital inmates, 31 patients were referred to as farmers or working for a farmer; while 702 patients were simply recorded as ‘country folk(s)’ (‘rusticus’, ‘rustica’).62 As the sheer number of patients and, where Finzel recorded them, the patients’ professions show, people from virtually all walks of society sought Finzel’s advice.63 Since Finzel’s contract did not include the free treatment of patients (except for hospital inmates), this suggests that many, if not most people—and not just a small elite—were able to afford his services. Finzel’s detailed records of the payments he received show that this was indeed the case. Some upper-class patients paid considerable sums—two, three, five or even more gulden for a single consultation and sometimes rewarded the medical treatment of their maidens and servants with similar generosity.64 For infinitely more patients, however, Finzel noted ‘g i’, or ‘g ii’, that is, 1 or 2 groschen, and the large majority of his patients did not pay more than 3 groschen for a consultation. Prices and monetary values are notoriously difficult to compare over time but Finzel’s own assessment of the monetary value of different edibles that patients gave him and other contemporary sources give at least a rough idea. According to Finzel’s calculations a hare was the equivalent of 6 to 8 groschen, and that of a big cheese 9 groschen. Several birds cost 7 groschen, a good calf including the tail, was worth roughly 80 groschen. According to other contemporary sources, around 1560, in the area around Hamburg and Lübeck, a chicken cost 1 groschen, ten eggs a bit less than that, and a pound of butter 1.5 groschen. In 1580, in Mecklenburg, one chicken was 1.5 groschen, a goose cost a bit more than 3 groschen; a journeyman in carpentry got 4 groschen a day, a thresher 1.5 groschen and food.65 Prices in Zwickau may have been somewhat different, but clearly most people would have been able to afford 1, 2 or even 3 groschen for a consultation. The Doctor–Patient Relationship The large number of different patients in Finzel’s practice and the modest social status of the majority of them raises intriguing questions, in turn, about the nature of the early modern doctor–patient relationship. When we compare the number of 8,746 consultations with the number of individual patients, 6,551, we find that Finzel recorded, on average, only about 1.34 consultations per patient. In other words, Finzel saw the large majority of his patients only once or twice. The figure for Palm’s practice in Nuremberg is not much higher. From June 1583 until April 1591, Palm recorded only 929 consultations for 380 patients, or a little more than 2.4 consultations per patient.66 In the mid-seventeenth century, Johannes Magirus in Zerbst recorded about 266 consultations for 97 patients, that is, about 2.75 consultations per patient.67 With female patients, especially, and with patients who lived in places outside of Zwickau, viz. Weimar, Finzel frequently does not even seem to have known—or remembered—their names. About 20 consultations are quite simply recorded as being for a ‘man’ (‘Man(n)’ and—the difference is very striking—522 for a ‘woman’ (‘Frau’) or a ‘girl’ (‘Jungfrau’, ‘puella’), usually together with their place of residence. Likewise, for about 550 of the 702 patients whom he recorded as ‘rustici’, we do not find a name but, at best, the place of residence. Presumably—but on this we have no specific information—many rural patients came to see Finzel in Zwickau, rather than calling on him to visit them in their homes. Three entries in his journal—including two from his time in Weimar—state explicitly that he only saw a patient’s urine without even indicating whether it was from a man or a woman. However, in view of the very common practice of uroscopy, Finzel may often have only seen the urine of his rural patients but not the patients themselves.68 All this does not suggest a particularly close and personal relationship and stands in marked contrast to the familiar image of the premodern physician who took care of his patients from the cradle to the grave and almost became part of the family. Many patients, it seems, were one-time customers rather than faithful patients. They were not looking for continuous treatment but they simply gave the physician a try. If his medicines worked that was fine—and if not they moved on to another medical practitioner. Once we look at patients of different social status, however, Finzel’s journal indicates that the image of the physician who took care of whole families and became a familiar figure in their homes is not pure fiction either. While many if not most people, at one point or another, consulted Finzel, his journal suggests that an ongoing therapeutic relationship that lasted over a period of years was primarily an upper-class phenomenon. Some patients from the higher ranks of society and especially from the aristocracy consulted him quite regularly, or, in certain cases, even dozens of times. Sometimes this was due, at least in part, to repeated consultations for one disease episode. For example, Finzel recorded 10 consultations for Wolf Rudolf von Planitz just from January to June 1572 and another 10 consultations in January and February of 1574, when he seems to have suspected the French disease, which called for fairly intensive treatment. Other noble patients called on Finzel’s services only every once in a while but for long periods of time. Christof von Oelsnitz, for example, consulted Finzel 31 times, from December 1572 until September 1587. Moreover, he frequently treated, at various times, different members of the same noble family. In fact, almost 60 per cent of his consultations for noble patients concerned members of only ten families: Albrecht (30), Auerbach (25), Enda (87), Kauffungen (50), Oelsnitz (53), von Planitz (197), Trutschler (23), Weisbach (199), Widebach (23), Wolframsdorf (51). Among these two—the Planitz and the Weisbach—stand out, in turn, with almost 200 consultations each. Here Finzel came, at times, close to serving as a family physician—even though different members of that family did not necessarily live in the same household. For a few noble families Finzel even recorded a ‘salary’, which he received at regular intervals. Wolf von Weisbach gave him 7 taler as a ‘half-year salary’, from Jörg Albrecht von Witzleben he received 30 gulden per year, and Heinrich von Enda paid him 10 taler for half a year.69 Yet, even for the upper classes, Finzel’s entries suggest a doctor–patient relationship that frequently was not particularly personal. With only about 2.5 consultations per patient (1,256 consultations for 493 patients), contacts were quite sporadic, on average, even among the nobility. Moreover, in about 40 consultations for his noble clientele (27 women and 15 men) he did not even identify the patient with his or her the name but only wrote ‘nobilis’, ‘nobilis puella’, ‘quidam nobilis’ and similar terms. All in all, a picture of the doctor–patient relationship emerges from Finzel’s journal that is quite different from what we have become accustomed to imagine. It was a relationship that was often much less personal and much less based on the kind of mutual trust that could build up from years of interaction—and remarkably reminiscent of patterns of behaviour in modern health care that have come to be described as ‘doctor shopping’. Conclusion Analysing thousands of entries in a patient journal is inevitably laborious and time-consuming. As I hope to have shown in this paper, it is also highly rewarding. It allows us to test and challenge well-established historiographical claims about early modern medical practice and the doctor–patient relationship, claims that have usually been based only on anecdotal evidence or on sources that reflect very specific groups of doctors and patients. To start with, Finzel’s journal—like Kirstenius’ prescription diary and Handsch’s extensive notes on the medicinal treatment of patients—confirms what is suggested already by the widespread interest in simples and the very lively circulation of medicinal recipes among physicians at the time: learned medical practice relied heavily on medicines (plus minor surgical interventions such as blood-letting and cupping). The dietetic tradition remained very much alive, especially in health advice books.70 Finzel very occasionally did record some dietetic advice, for a high-ranking patient, and we find the same in Handsch’s case notes. Moreover, regimens that were (supposedly) tailored to the individual patient’s constitution and his or her life style featured quite prominently in many written medical consultations. The extant evidence suggests, however, that physicians elaborated such individualized dietetic advice primarily for a small group of upper-class patients. In ordinary medical practice, by contrast, regimens seem to have played only a marginal role: Physicians gave little advice and much medicine rather than the opposite. As to the gender and age of his patients, Finzel’s journal demonstrates a predominance of male patients. This is a familiar finding in the early modern period although the reasons remain unclear. More surprising is the remarkable number of infants and children in Finzel’s practice. Clearly, even the very young were not always left to their fate or entrusted to the care of midwives or ‘wise women’ or other lay practitioners. When it comes to the social status of the physician’s patients, finally, Finzel’s journal calls for nothing less than a substantial revision of long-held beliefs about the place and the role of learned medical practice in the sixteenth century. The aristocratic minority among Finzel’s patients was more likely to consult him on a regular basis and from some he even received a regular salary. However, the large total number of patients in Finzel’s practice, the modest fees of 1, 2 or 3 groschen per consultation most of them paid, and the numerous artisans and country-folks who sought his advice make it clear that Finzel’s services were accessible to and used, at one time or another, by large parts of the population. One of the principal, recurring provisions that we find in many town physicians’ contracts at the time was that they offered their services to rich and poor alike and without charging excessive fees.71 Finzel’s journal demonstrates that this provision was not just rhetorical—and that the town councils got what they wanted. And by paying them a salary that guaranteed a basic level of subsistence, they helped the physicians, in turn, to assume an increasingly important role in the health care of the population at large. Michael Stolberg is director of the Institute of the History of Medicine at the University of Würzburg, Germany. He has published widely on the history of early modern medicine and the body as well as on the history of medical ethics and palliative care. Drawing, in particular, on manuscript sources such as the personal notebooks and practice journals of medical students and physicians, his current work focuses on medical training and the world of ordinary medical practice in sixteenth-century Europe. Footnotes 1 On the figure of the early modern town physician see Andrew W. Russell, ed., The Town and State Physician in Europe from the Middle Ages to the Enlightenment (Wolfenbüttel: Herzog-August-Bibliothek, 1981); Ruth Schilling, Sabine Schlegelmilch and Susan Splinter, ‘Stadtarzt oder Arzt in der Stadt? Drei Ärzte der Frühen Neuzeit und ihr Verständnis des städtischen Amtes’, Medizinhistorisches Journal, 2011, 46, 99–133; there are numerous smaller and mostly older studies on individual town physicians and histories of town physicians in certain localities. See e.g. Werner Bubb, Das Stadtarztamt zu Basel. Seine Entwicklungsgeschichte vom Jahre 1529 bis zur Gegenwart. Diss. med. Basel (Zürich: Leemann, 1942); Karl Heinz Burmeister, ‘Die Lindauer Stadtärzte Dr. med. Johann Mürgel (1494–1561) und Dr. med. Abraham Mürgel (1524–1594)’, Jahrbuch des Landkreises Lindau, 2000, 15, 36–42; Oswald Feis, ‘Aus der Praxis eines spätmittelalterlichen Frankfurter Stadtarztes’, Sudhoffs Archiv, 1922–23, 14/15, 98–104; Karl Leuthardt, Das Stadtarztamt zu Basel; seine Entwicklungsgeschichte bis zum Jahre 1529. Diss. med. Basel 1940 (Zürich: Leeman,1940); Gerhard Naber, Der Arzt als städtischer Amtsträger im alten Amberg (Erlangen−Nürnberg: typescript diss. med. 1967); Hubert Patscheider, ‘Die Stadtärzte im alten St. Gallen’, Schriften des Vereins für Geschichte des Bodensees und seiner Umgebung, 1997, 115, 89–132; Yvonne Thurnheer, Die Stadtärzte und ihr Amt im alten Bern (Bern: Haupt, 1944). 2 For overviews see Laurence W. B. Brockliss and Colin Jones, The Medical World of Early Modern France (Oxford: Clarendon, 1997); Mary Lindemann, Medicine and Society in Early Modern Europe, 2nd edn (Cambridge: Cambridge University Press, 2010). 3 Harold J. Cook, ‘Good Advice and Little Medicine. The Professional Authority of Early Modern English Physicians’, Journal of British Studies, 1994, 33, 1–31. 4 Early examples are Antonio Benivieni, De abditis non nullis ac mirandis morborum et sanationum causis (Florence: Giunta, 1507); Amatus Lusitanus, Curationum medicinalium centuria prima, multiplici variaque rerum cognitione referta (Florence: Laurentius Torrentinus, 1551); François Valleriola, Observationum medicinalium libri sex (Lyon: Andrea Gryphius, 1573); Rembertus Dodonaeus, Medicinalium observationum exempla rara, recognita et aucta, 2nd edn (Cologne: Cholinus, 1581); on the growing importance of printed collections of medical observations as a literary genre see Michael Stolberg, ‘Formen und Funktionen ärztlicher Fallbeobachtungen in der Frühen Neuzeit (1500–1800)’, in J. Süßmann, S. Scholz and G. Engel, eds, Formen und Funktionen ärztlicher Fallbeobachtungen in der Frühen Neuzeit (1500–1800) (Berlin: trafo 2007), 81–95; Gianna Pomata, ‘Sharing Cases: The Observationes in Early Modern Medicine’, Early Science and Medicine, 2010, 15, 193–236. 5 As François Valleriola explained, for example, the 60 cases he published in 1573 were taken from more than 600 histories of ‘more serious’ cases in his own practice, suggesting that the number of patients he had actually treated was much higher (Valleriola, Observationum, 263). 6 Even in the case of Pieter van Foreest who published the largest collection of observations by far (Pieter van Foreest, Observationum et curationum medicinalium libri (Leiden: Plantin, 1590ff), we do not know how many of the cases he treated actually made it into his observations and to what degree he selected cases for publication, for example, because they highlighted his diagnostic acumen and his therapeutic skills. Brian Nance, Turquet de Mayerne as Baroque Physician. The Art of Medical Portraiture (Amsterdam/New York: Rodopi, 2001); for the nineteenth and twentieth centuries see Elisabeth Dietrich-Daum, Martin Dinges, Robert Jütte and Christine Roilo, Arztpraxen im Vergleich: 18.−20. Jahrhundert (Innsbruck: StudienVerlag, 2008). 7 Martin Dinges, Kay Peter Jankrift, Sabine Schlegelmilch and Michael Stolberg, eds, Medical Practice, 1600–1900. Physicians and Their Patients (Leiden: Brill, 2016). 8 Lauren Kassell, ‘Casebooks in Early Modern England: Medicine, Astrology, and Written Records’, Bulletin of the History of Medicine, 2014, 88, 595–625, esp. pp. 614–5. 9 URL: www.magicandmedicine.hps.cam.ac.uk/; see also Michael MacDonald, Mystical Bedlam: Madness, Anxiety, and Healing in Seventeenth-century England (Cambridge: Cambridge University Press, 1981), which draws on these casebooks; the most extensive collection that has survived from the early seventeenth century are the notes of Théodore Turquet de Mayerne (1573 − 1655); cf. Nance, Turquet. 10 For Palm see Stadtbibliothek Nürnberg, Ms. Cent. V, 10b; Germanisches Nationalmuseum, Nürnberg, Hs 100.822; cf. Klaus G. König, Der Nürnberger Stadtarzt Dr. Georg Palma (1543 − 1591) (Stuttgart: Gustav Fischer, 1961); for Magenbuch, see Universitätsbibliothek Heidelberg, Cpl 1895–1 (the original manuscript is in the Vatican library) and cf. Peter Assion and Joachim Telle, ‘Der Nürnberger Stadtarzt Johannes Magenbuch. Zu Leben und Werk eines Mediziners der Reformationszeit’, Sudhoffs Archiv, 1972, 56, 353–421. 11 Michael Stolberg, ‘Empiricism in Sixteenth-century Medical Practice. The Notebooks of Georg Handsch’, Early Science and Medicine, 2013, 18, 487–516; Stolberg, ‘Learning from the Common Folks. Academic Physicians and Medical Lay Culture in the Sixteenth Century’, Social History of Medicine, 2014, 27, 649–67. 12 Ratschulbibliothek (RSB) Zwickau, Ms. QQQQ1a, QQQQ1 and QQQQ1b; from April 1565 until February 1567 Finzel only recorded about 60 consultations and his journal entries were probably not complete. 13 Hiob Finzel, Wunderzeichen (Nürnberg: Johann vom Berg and Ulrich Neuber, 1556–62). The literature on Finzel’s Wunderzeichen is quite extensive. For good overviews see Heinz Schilling, ‘Job Fincel und die Zeichen der Endzeit’, in W. Brückner, ed., Volkserzählung und Reformation. Ein Handbuch zur Tradierung und Funktion von Erzählstoffen und Erzählliteratur im Protestantismus (Berlin: Erich Schmidt Verlag, 1974), 326–93; Björn Aewerdieck, Register zu den Wunderzeichenbüchern Job Fincels (Frankfurt am Main: Lang, 2010), 7–54 (introduction). 14 See the detailed biographical sketch in Aewerdieck, Register, 10–21, and the collection of extracts from the relevant biographical sources ibid., 277–85. 15 In contemporary sources Finzel figures as ‘Vinariensis’, i.e. ‘from Weimar’ (Johannes Ursinus, Epithalamion in nuptiis doctissimi viri Magistri Iobi Fincelij Vinariensis, et pudicae virginis, Susannae, filiae viri integerrimi Nicolai Stigelij, pridem pie defuncti (Jena: Rödinger, 1555; Karl Eduard Förstemann, ed., Album Academiae Vitebergensis: ab a. CH. MDII usque ad a. MDLX (Leipzig: Leipzig, 1841), 218, with Finzel’s immatriculation record in Wittenberg. In principle, this could also mean that he came from the area around Weimar but in his epicedion for his sister Finzel clearly refers to Weimar itself as her—and thus presumably also his own—native city (Hiob Finzel, Epicedion honestae puellae Annae Finceliae Vinariensis pie defunctae in Pomerania (Jena: Rödinger, 1556)). 16 Förstemann, Album, 218, ‘Hiob Funtzschel’; Adrian Beier, Syllabus rectorum, et professorum Jenae (Jena: typis Caspari Freyschmidii, 1659), 896 and 968. 17 Beier, Syllabus, 968. 18 For his published poetry, see Hiob Finzel, Elegia Tyrtaei poetae antiquissimi (Magdeburg: Lottherus, 1550); Finzel, ‘Epithalamium in nuptiis Doctissimi viri M. Davidis Chytraei’, in J. Stigel et al., Ioannis Stigelii elegia, qua celebratur dignitas et fructus legitimi coniugij, scripta in nuptijs doctissimi viri Davidis Chytraei professoris Academiae Rostochianae, et alia epithalamia scripta a Iobo Fincelio, Nicolao Cisnero, & Iohanne Willebrochio (Wittenberg: Iohannes Crato, 1553), no pagination; Finzel, ‘Ad illustrissimum principem ac dominem D. Ioannem Fridericum II. ducem Saxoniae’, in J. Stigel, In nuptiis illustrissimi Principis ac domini Joannis Friderici II. Ducis Saxoniae .^.^. et Agnae, natae Principis Hessorum, epithalamion. Accesserunt & aliorum carmina (Jena: Rödinger, 1555), no pagination; later, Finzel also edited the poems of his mentor, the theologian and poeta laureatus Johann Stigel, for whom he also wrote the funeral sermon (Finzel, Hiob, In obitum summi et clarissimi poetae Johannis Stigelii epicedion (Jena: Rebart, 1562). 19 Georg Agricola (1530 − 1574), for example, first served as rector of the school in Amberg for about 15 years and obtained his medical doctorate only about 16 years after his master’s degree (Naber, Arzt, 113). Some future physicians even first turned to theology. Jacob Degen aka Schegk, for example, first studied theology and was ordained as a priest and only then turned to medicine (Miriam Eberlein, ‘Die Medizinische Fakultät im späten 16. Jahrhundert’ in U. Köpf, S. Lorenz and D. R. Bauer, eds, Die Universität Tübingen zwischen Reformation und Dreißigjährigem Krieg. Festgabe für Dieter Mertens zum 70. Geburtstag (Osterfildern: Thorbecke, 2010), 249–98). 20 Ioannes Schroterus, Themata de peste. Praes. Ioanne Schrotero. Respondebit M. Iobus Fincelius (Jena: Rebart, 1562). 21 RSB Zwickau, Ms. QQQQ1a, 163. 22 At the time, there were three hospitals for the poor in Zwickau (Emil Herzog, Chronik der Kreisstadt Zwickau, II (Zwickau: Zückler, 1839), 330). 23 Stadtarchiv Zwickau, Sign. A A II, 11, Nr 12, 1r–2r, reproduced in Aewerdieck, Register, 277. 24 RSB Zwickau, Ms. QQQQ1a, 275 details Finzel’s start in Zwickau. 25 Staatsarchiv Coburg, LA A 10529, 125r–v, letter from Finzel to the captive Duke Johann Friedrich, Zwickau, 6 June 1572. 26 According to Herzog, Chronik, 319, Finzel died on 1 July 1589; Herzog probably still had access to the parish registers which are no longer extant; in December 1589, Finzel’s successor as town physician, Petrus Poach, received his first salary. Earlier dates like 1568 (Ernst Giese and Benno von Hagen, Geschichte der Medizinischen Fakultät der Friedrich-Schiller-Universität Jena (Jena: 1985), 125) or 1582 in the Wikipedia entry (https://en.wikipedia.org/wiki/Jobus_Fincelius, acccessed 28 April 2017) are proven wrong by his ongoing publications and by his journal. 27 The Ratschulbibliothek also holds a whole collection of Poach’s correpondence (Ratschulbibliothek Zwickau, Sign. J). 28 A good seventeenth-century example is the carefully drafted and beautifully illustrated collection of medical cases by Johann Frank in Ulm (Stadtarchiv Ulm, Mss Franc 8a and 8b). 29 For a detailed analysis of the economic aspects of Finzel’s practice and of his approach to accounting see Michael Stolberg, ‘Accounting in 16th-century Medical Practice: Hiob Finzel’s Rationarium praxeos medicae, 1565 − 1589’ (contribution to a forthcoming collective volume on the history of accounting and medicine, ed. by A. Hüntelmann and O. Falk). 30 In this respect Finzel’s journal resembles the (typically narrow, long) recipe journals that were often kept in the pharmacies at the time and into which the prescriptions of the physicians were entered. Some seventeenth-century examples are Germanisches Nationalmuseum Nürnberg, Historisches Archiv, Pharmaceutica, No. 3 (Ingolstätter), No. 14 (Blendinger) and No. 15 (Göckel). 31 Stolberg, ‘Empiricism’. 32 RSB Zwickau, Ms. QQQQ1a, 168 and 371; ibid., Ms. QQQQ1, 42. Finzel may have used a special notebook to record therapeutic effects and other observations. In his journal, he mentioned ‘my little book’ in which he had noted a patient’s symptoms and he also referenced ‘my diary’—which may have been the same—for the recipe of a decoctum magistrale; cf. RSB Zwickau, Ms. QQQQ1a, 373, ‘Accidentia sunt comprehensa in meo libello’; ibid., 145, ‘vide in diario meo’. 33 RSB Zwickau, Ms. QQQQ1a, 260; ibid., 265. 34 Notes on political events can be found at RSB Zwickau, Ms. QQQQ1a, 90, while the judgement of von Enda’s wife is at RSB Zwickau, Ms. QQQQ 1, 433, January 1577, ‘Ist inn dem Jar zur Huren worden’. 35 I gratefully acknowledge the invaluable assistance of Hannes Langrieger, who did much of this initial, laborious work of entering names and data into a computer. 36 My figures include 176 consultations that ended up on pages at the very end of the last volume, when the fascicles were bound, but which clearly refer to 1585 and end with Fincel’s calculation of his earnings in 1585. 37 There is some margin of error. On the one hand, Finzel may sometimes not have recorded every single consultation, when he saw a patient very often and was not paid for every single visit. On the other hand, entries which only indicate a name and a certain sum of money may sometimes not reflect an actual consultation but only a payment for previous consultations. Since many patients for whom he only recorded the name and the amount paid do not figure a second time in the journal, at least not without indicating another payment, we can safely assume, however, that even entries that consist only of name and payment usually reflect a consultation. 38 The precise figure is 614 consultations in 23 months (RSB Zwickau, Ms. QQQQ1a). 39 Stadtbibliothek Nürnberg, Ms. Cent. V, 10b. The precise figure is 929 consultations in 94 months; it is based on Palm’s own index to his journal which lists the patients’ names alphabetically with the various page numbers on which they appear. 40 In Ms QQQQ 1b, individual fascicles were bound in the wrong order, sometimes with certain pages missing, which have to be identified elsewhere, sometimes with a seemingly continuous pagination—e.g. a fascicle ending with fol. 6v, followed by one beginning with fol. 7r—but clear evidence (primarily from Finzel’s interim calculations of his earnings) that the fascicle actually belongs to a different year. My figures are based on what I take to correspond to the true chronological order but a smalll margin of error remains. 41 See e.g. Giovanni Battista da Monte, Consultationes medicae ([Basel: Waldkirch], 1583) on the tradition of the Padua school. 42 On Galenist medical practice see Andrew Wear, ‘Medicine in early modern Europe 1500–1700’, in I. C. Lawrence, M. Neve, V. Nutton, R. Porter and A. Wear, eds, The Western Medical Tradition, 800 BC to AD 1800 (Cambridge: Cambridge University Press, 1995), 215–361; Andrew Wear, Roger French and Iain Lonie, eds, The Medical Renaissance of the Sixteenth Century (Cambridge: Cambridge University Press, 1985); Andrew Wear, Knowledge and Practice in English Medicine, 1550 − 1680 (Cambridge: Cambridge University Press, 2000). 43 On the complex history (and historiography) of premodern hysteria see Helen King, ‘Hysteria Beyond Freud’ in S. L. Gilman, H. King, R. Porter, G.S . Rousseau and E. Showalter, eds, Once Upon a Text. Hysteria from Hippocrates (Berkeley: University of California Press, 1993), 3–90. 44 For the seventeenth century, see Katherine E. Williams, ‘Hysteria in Seventeenth-century Case Records and Unpublished Manuscripts’, History of Psychiatry, 1990, 1, 383–401. 45 In some cases Finzel explicitly diagnosed a praefocatio matricis ‘ex mensibus impeditis’, i.e. from a retention of the menses. 46 RSB Zwickau, Ms QQQQ1, 99. 47 See e.g. Montius, Pamphilus, Methodus medendi (Augsburg: Henricus Steynerus, 1540); Valles, Francisco, Methodus medendi (Venice: Georgius Angelerius, 1589); Riolan, Jean, Methodus generalis bene medendi: ad omnes morbos recta ratione curandos summe utilis et necessaria (Lyon: Faber, 1589). 48 RSB Zwickau, Ms QQQQ1a, 279 (1571). 49 For contemporary writing on pediatrics, see Sebastianus Austrius, De infantium sive puerorum morborum et symptomatorum dignitione tum curatione liber (Basel: apud Bartholomeum Westhemerum, 1540); Leonellus Faventinus de Victoriis, De aegritudinibus infantium tractatus admodum salutifer (Venice: Valgrisius, 1557); Omnibonus Ferrarius, De arte medica infantium quorum duo priores de tuenda eorum sanitate, posteriores de curandis morbis agunt (Brixen: de Marchettis, 1577); Girolamo Mercuriale, De morbis puerorum tractatus (Venice: apud Paulum Meietum, 1583). On obstetrics, see the highly successful collection of gynaecological texts in Kaspar Wolf, ed., Gynaeciorum, hoc est, de mulierum tum communibus, tum aliis, tum gravidarum, parientium, et puerperarum affectibus et morbis libri (Basel: Thomas Guarinus, 1566), with further editions in 1586 and 1597; cf. Helen King, Midwifery, Obstetrics and the Rise of Gynaecology. The Uses of a Sixteenth-century Compendium (Aldershot: Ashgate, 2007); Monica Green, Making Women’s Medicine Masculine. The Rise of Male Authority in Pre-modern Gynecology (Oxford: Oxford University Press, 2008). 50 E.g. Roy Porter and Dorothy Porter, Patient’s Progress. Doctors and Doctoring in Eighteenth-century England (Cambridge: Polity Press, 1989), 183. 51 Stadtbibliothek Nürnberg, Ms. Cent. V, 10b, based on Palm’s own index to his journal which lists the patients’ names alphabetically; Franziska Ofenhitzer, Praxisalltag in der Frühen Neuzeit. Das Rezeptdiarium (1612–1616) von Petrus Kirstenius aus Breslau (Würzburg: typescript med. diss., 2015), 92. 52 In addition to those referring generically to ‘infants’ and ‘children’, ten further entries do not reveal the gender of the patient. 53 Ofenhitzer, Praxisalltag, 91. 54 This includes noblewomen; see Alisha Rankin, Panaceia’s daughters. Noblewomen as Healers in Early Modern Germany (Chicago and London: University of Chicago Press, 2013). 55 Presumably, when Finzel recorded no place of residence, the patient was from Zwickau or, before he moved there, from Weimar or Eisenach. 56 Nicholas D. Jewson, ‘Medical Knowledge and the Patronage System in 18th Century England’, Sociology, 1974, 8, 369–85. 57 See, e.g., the various contributions in Dinges et al., Medical Practice. 58 Helmut Bräuer, Wider den Rat. Der Zwickauer Konflikt 1516/17 (Leipzig: Leipziger Universitätsverlag, 1999), 34 estimates the population to have been around 7,300 in 1530; Hildegard Berthold, Karl Hahn and Alfred Schultze, eds, Die Zwickauer Stadtrechtsreformation 1539/69 (Leipzig: Hirzel: 1935), 2, arrive at 7,677 inhabitants in the mid-sixteenth century. 59 Günter Grosche, Zwickauer Ärzte und Apotheker im 16. Jahrhundert (Zwickau: unpublished typescript, 2000 = Stadtarchiv Zwickau, Sign. I M 512), 7–8. Moreover, from 1577 to 1587, we find Andreas Schultheiß from Prenzlau. He was also a pharmacist, however, and it remains unclear whether he actually treated patients. Grosche concluded from his thorough acquaintance with the local archives that, in sixteenth-century Zwickau, usually three to four physicians were active at the same time (ibid., 9); see also Anett Drechsel, Das Gesundheitswesen der Stadt Zwickau von den Anfängen bis zum Ausgang des 17. Jahrhundert (Leipzig: typescript medical dissertation, 2003). 60 Finzel seems to have indicated quite consistently when patients came from noble families. Nevertheless his records are sometimes not entirely clear. An entry on a ‘Frau von Auerbach’, for example, may have referred to a woman coming from the town of Auerbach—or to a member of the noble family of that name. 61 Since Finzel frequently only gave the name or the profession and did not always use Latin terms, there is some uncertainty especially in the case of professions which were also common names, such as blacksmiths (‘faber ferrarius’ but also ‘Schmid’), tailors (‘sutor’, ‘sartor’ but also ‘Schneider’) and bakers (‘pannifex’ but also ‘Beck’): we cannot always be sure that a patient identified e.g. as ‘Schneider’ was a tailor (in German ‘Schneider’) or just went by that name. 62 Twelve patients were identified as strangers or travellers (‘peregrinus’). 63 Sabine Schlegelmilch has come to the same conclusion for Johannes Magirus who practised around 1650 in Zerbst (Ruth Schilling, Sabine Schlegelmilch and Susan Splinter, ‘Stadtarzt oder Arzt in der Stadt? Drei Ärzte der Frühen Neuzeit und ihr Verständnis des städtischen Amtes’, Medizinhistorisches Journal, 2011, 46, 99–133), 107. 64 Finzel got a whole gold piece (‘Goltgulden’), for example, for treating the servant (‘Knecht’) of Jörg Marschall (RSB Zwickau, Ms. QQQQ1a, 47). 65 Heinz Voigtlaender, Löhne und Preise in vier Jahrtausenden (Speyer: Numismatische Gesellschaft Speyer, 1994). 66 Stadtbibliothek Nürnberg, Ms. Cent. V, 10b; figures based on Palm’s index, with the different pages on which entries on one and the same patient could be found. 67 Schilling, Schlegelmilch and Splinter, ‘Stadtarzt’, 107. 68 RSB Zwickau, Ms. QQQQ1a, 58, ‘Tannroda, duae urinae’; ibid., 332, ‘Urin von Glauchaw’. On the outstanding importance of uroscopic diagnosis at the time, see Michael Stolberg, Uroscopy in Early Modern Europe (Farnham: Ashgate, 2015). 69 On von Weisbach, see RSB Zwickau, Ms. QQQQ1a, 385, ‘halb Jar Besoldung’; ibid., Ms. QQQQ1, 39; on Albrecht, see RSB Zwickau, Ms. QQQQ1a, 42, ‘Jar Besoldung’; on von Enda, see RSB Zwickau, Ms. QQQQ1, 39 ‘halbe Jar Besoldung’. 70 Sandra Cavallo and Tessa Storey, Healthy Living in Late Renaissance Italy (Oxford: Oxford University Press, 2014); David Gentilcore, Food and Health in Early Modern Europe. Diet, Medicine and Society, 1450 − 1800 (London: Bloomsbury Academic, 2016). 71 See the Würzburg database on early modern physicians’ letters which also includes such contracts, as addressed to individual physicians or confirmed by them (www.aerztebriefe.de). © The Author 2017. Published by Oxford University Press on behalf of the Society for the Social History of Medicine.

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Social History of MedicineOxford University Press

Published: Sep 8, 2017

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