_Age of Transition (continued).--Arabic Period: A.D. 640-1400. Alkindus,
873. Mesue, 777-857. Rhazes, 850-932. Haly-Abas, 994. Avicenna,
980-1037. Albucassis, 1122. Avenzoar, 1113-1161. Averroës, 11661198.
Maimonides, 1135-1204. School of Salernum: Constantinus Afri-canus,
1018-1085. Roger of Salerno, 1210. Roland of Parma, 1250. The Four
Masters, 1270 (?). John of Procida._
The Arabic{057} Period, which began with the second destruction of the
Alexandrian Library--640 A.D.--ends with the fourteenth century. At
the commencement of this period the Roman Empire of the West scarcely
existed: the magnificent territory which composed it had been overrun
and subdued by barbarous tribes from the forests of the North, while
from its ruins had risen several independent kingdoms,--that of the
Franks in Gallia, of the Visigoths in Spain, and of the Lombards in
Italy. The last of the Western emperors of note was Justinian, whose
army and generals--especially the genius and heroic devotion of
Belisarius--threw some glory upon Italy, Sicily, Africa, and Spain.
Meantime the Empire of the East, surrounded by enemies, and harassed
from all directions, still sustained itself with vigor. The Turks had
begun to show themselves on the banks of the Danube; those eternal
enemies of Rome--the Persians--made incessant war; and a new and
terrible enemy had sprung up in the deserts of Arabia. Then came one
who was at the same time legislator, prophet, and conqueror, and united
under one faith and one leader tribes hitherto divided and warring
against each other. Thus arose a powerful and enthusiastic nation,
animated by thirst for conquest and ardor for proselytism. In less than
a century after the first preaching of Mahomet, all of Arabia, India,
Syria, and Egypt were in the hands of his followers. In the year 640
Amrou effected the conquest of Egypt, seized Alexandria, and the
great library of five hundred thousand volumes was, by order of Omar
(successor to{058} Mahomet), delivered over to the flames; and the
historian Abulpharagius declares that these books served for six months
to heat the public baths, four thousand in number. Such were the first
fruits of the establishment of Islam. * Happily, zeal of proselytism
somewhat abated among the Mussulman princes, and religious fervor gave
place to policy; so that the later Arabian caliphs showed themselves,
in general, the protectors of the arts and sciences. Some, indeed,
endeavored to collect the _débris_ of the scattered treasures that
had been so fortunate as to escape the ignorant fanaticism of their
predecessors; and others, more tolerant even than the Christian princes
of the time, received without distinction all men of merit who took
refuge in their State, gave them employment, and recompensed them for
their services. On this account philosophers and persecuted "heretics"
sought an asylum among infidels, and found there the protection which
Christianity did not afford,--in return for which they gave their
protectors the benefits of Greek civilization.
* See a very vigorous denial of this historical statement in
The Nineteenth Century, October, 1894, page 555.
Of all the Moslem rulers, the most distinguished for love of learning
and general enlightenment was Haroun-al-Raschid, the Charlemagne of
the East, contemporary and emulator of the glory of the emperor of the
Franks, the hero of a hundred Arabic poems, whose dominion extended
from the borders of the Indus to the heart of the Spanish peninsula.
He embellished Bagdad, his capital, with schools and hospitals. His son
Almamon founded the Academy of Bagdad, which became the most celebrated
of the age; likewise spared no pains to draw to his court the most
illustrious men of all countries. He enjoined each of his ambassadors to
purchase all the writings of the philosophers and physicians that
could be found, and these he required to be translated into Arabic; his
interpreter, Honain, a Christian, was employed at translating for
forty-five{059} years, and received, for each book rendered into Arabic,
literally its weight in gold.
The eclat which the Moorish caliphs shed upon Spain from the tenth to
the thirteenth century is well known. The cities of Cordova, Toledo,
Seville, and Murcia possessed public libraries and academies, and
students from all parts of Europe flocked to them to be instructed in
arts and sciences; the library of Cordova alone embraced more than two
hundred and twenty-four thousand volumes. Thus it will be seen that
the dominion of mental and temporal affairs passed from the Greeks and
Romans to the Saracens.
Arabian medicine constitutes one of the most interesting chapters in the
history of our art. An offspring from Greek schools, it was for nearly
one hundred years the fostermother of that art, and, although it gave
rise to no great discovery nor wonderful step in advance during all this
period, it nevertheless kept alive all the learning of the past,
and clarified rather than made it turbid. In the sixth century the
Nestorians (followers of Bishop Nestor), having been driven out of
Syria, settled in Persia, Mesopotamia, and Arabia, and there founded
schools and other institutions such as they had had at home,--schools
in which, beside the ordinary philosophic studies, medicine received
a share of attention. Thus it came about that by the seventh century
Arabian physicians were everywhere known and in high repute. Naturally
the basis for their studies embodied the writings of Hippocrates, Galen,
Oribasius, and Paul of Ægina; and the first Arabian works consisted
solely of translations from the Greek, first out of their Syriac
rendering, and later from the originals. Indeed, so much eminence was
finally achieved by Arabian physicians that more than four hundred are
known by name as authors.
The first author deserving of mention was _Bachtischua_, of Nestorian
stock, celebrated in Jondisapur, director of the medical school, and
later physician to Caliph El-Mansur, in Bagdad.{060} Of his descendants
several became well known in the same field.
Alkindus--this being the Latin arrangement of his Arabic name--came from
a Persian family, who lived first in Basara and later at the court of
the caliphs El-Monon and El-Motasin, in Bagdad. He enjoyed a very high
reputation as physician, philosopher, astronomer, and mathematician, and
died A.D. 873. Mesue, the first of his name, sometimes known as Janus
Damascenus, was director of the hospital in Bagdad and physician to
Haroun-al-Raschid. He was born in 777, wrote extensively (since at least
forty of his works have been catalogued), and died in 857 in Samarra.
Serapion the elder, also sometimes known as Janus Damascenus, and whose
Arabic name was Serafiun, was born in Damascus--the exact data is
not known--and died some time prior to A.D. 930. He was author of two
volumes of aphorisms concerning the practice of medicine, which had at
his time the greatest repute.
The most celebrated of the early Arabian physicians was Rhazes, born in
the Persian province of Khorassan A.D. 850. According to the historians
of his nation he was a universal genius, equally famous in music,
astronomy, mathematics, chemistry, and medicine; he was surnamed "The
Experienced." At the age of fifty he was one of the most distinguished
professors in the Academy of Bagdad, where students came from great
distances to listen to him. Chosen from among a hundred colleagues to
direct the grand hospital of that city, he displayed indefatigable zeal
and most scholarly learning, even to his old age and in spite of loss of
sight, which overtook him at the age of eighty, when his reputation was
at its height. Two years after this misfortune--i.e., in 932--he died.
His generosity, which was proverbial, and his compassion for the poor
left him penniless at the time of his death. Some two hundred and
thirty-seven monographs of his have been{061} catalogued, though the
greater number of his works are practically lost. Two treatises on
medicine remain which afford excellent counsel in many respects; among
other matters he advises:--
"Study carefully the antecedents of the man to whose care you propose
to confide all you have most dear in this world,--that is, your life and
the lives of your wife and children. If the man is dissipated, is given
to frivolous pleasures, cultivates with too much zeal the arts foreign
to his profession, still more if he be addicted to wine and debauchery,
refrain from committing into such hands lives so precious."
His greatest publication was _Continens_--extracts compiled from all
authors for his own use--divided into thirty-seven books, constituting
an abridgment of the science of medicine and surgery up to his time;
and, notwithstanding its imperfect state, this work was held in greatest
reverence, and was a common source of knowledge among Orientals long
after his day.
Haly-Abbas, a Persian by birth, flourished fifty years after Rhazes, and
died A.D. 994. His _Almalelci_, in twenty volumes, constituted a quite
complete system of theory and practice of medicine, which, however,
was in large measure taken from Rhazes's _Continens_. It is generally
regarded as the best work of any of the physicians of the Arabic Period;
it is divided into three parts--a book on Health, a book on Death, and a
book of Signs--and it is interesting to know that the portion devoted
to midwifery and obstetrics was in the hands not only of the profession,
but also of the midwives.
Avicenna--Latinized form of his Arabic name, Ebn Sina--was born in
Bokhara in 980. From his earliest youth he manifested a remarkable
disposition for scientific study, and it is claimed that he mastered the
entire Koran at the age of ten years; also that he devoted his
entire days and the greater part of his nights to research, mastering
philosophy,{062} mathematics, astronomy, and, later, medicine, which
he studied at the university at Bagdad, in which city his talents were
chiefly exhibited. He was received at court, loaded with favors, and
elevated to the dignity of Vizier, but suddenly fell into disgrace, was
deprived of property, imprisoned, and even threatened with execution.
After two years, however, he was restored to liberty, and once more
possessed the consideration of the public and the court, becoming
the recipient of new honors. Meantime he had given himself up
to intemperance, by which his previously robust constitution was
undermined, and this, with excessive labor, brought about his demise
at the too early age of fifty-six, in the year 1037. He was author of
several books, the chief being the _Canon Medicinae_, which remained
a classic for six centuries, constituting the medical code of Asia
and Saracenic Europe; no author since Galen had enjoyed so wide and
extensive authority in the medical world; and in the various medical
schools professors, for the most part, confined themselves to reading
the _Canon_ from their desks, explaining and commenting upon its text.
The work was divided into five volumes, of which the first two comprised
the principles of physiology, pathology, hygiene, and therapeutics,
arranged to conform to the teachings of Aristotle and Galen; the third
and fourth dealt with treatment; and the fifth wras devoted to the
preparation and composition of remedies. Avicenna appears to have
surpassed in subtlety both Aristotle and Galen; he was fond of
metaphysical speculation, and his works were too much filled out with
subtleties of language rather than with true science. Authors of this
period were fond of torturing in every way possible the writings
which they undertook to edit or quote from, and, instead of devoting
themselves to original research, wasted time in seeking for vague and
hidden meanings. That man was most esteemed as learned who could see the
greatest subtlety in some passage from one of{063} the ancient writers;
consequently, that which was obscure or unintelligible was deemed the
most sublime and philosophic. A very brief study of the _Canon_, for
instance, will show this, while in graphic pictures of disease the work
by no means approaches those of Aretæus or Alexander of Tralles, for
Avicenna too often contented himself with mentioning merely a list of
symptoms without indicating in any way their progression, characters,
or duration. Undoubtedly just was the criticism of an Arabian poet: "His
philosophy had no sound foundation, and his medical knowledge availed
him naught for the possession of personal health and long life."
Albucassis was born in Zahra, near Cordova, about the beginning of
the eleventh century, and is supposed to have died A.D. 1122, at the
advanced age of one hundred and one. He was author of an abridgment, or
compilation, devoted to the practice of medicine, the only novelty of
which is a small portion devoted to surgery, in which are described
certain instruments. He says:--
"I have detailed briefly the methods of operations; I have described all
necessary instruments, and I present their forms by means of drawings;
in a word, I have omitted nothing of what can shed light to the
profession.... But one of the principal reasons why it is so rare to
meet a successful surgeon is that the apprenticeship of this branch
is very long, and he who devotes himself to it must be versed in the
science of anatomy, of which Galen has transmitted us the knowledge....
In fine, no one should permit himself to attempt this difficult
art without having a perfept knowledge of anatomy and the action of
remedies."
Not a word is said about dissections, however, from which we conclude
that they were not tolerated in his time. He resorted enthusiastically
to the cautery, and recommended it in spontaneous luxations and the
commencement of curvature of the spine. He refers particularly to
instrumental{064} delivery and the extraction of the after-birth, and,
when speaking of fractures and dislocations, he remarks: "This part of
surgery has been abandoned to men of vulgar and uncultivated minds, for
which reason it has fallen into undeserved contempt."
[Illustration: 0084]
Avenzoar, born in 1113, of a Spanish family which had many illustrious
scions, was instructed in medicine by his father, and ultimately
achieved great celebrity throughout Spain and Africa; for a time he
lived at the court of the Prince of Seville, loaded with honors and
presents, and finally was made Vizier. Among other works he wrote
a treatise on renal diseases, in which he outlined the treatment of
calculus and described an operation therefor. He died in 1161.
Averroës (as he is generally known, though his Arabic name was Aben
Roschd) was born A.D. 1166, in Cordova, where{065} his father held
official position. After being grounded in philosophy, mathematics, and
other sciences he became a pupil in medicine under Avenzoar. The greater
part of his life wras passed in Seville, where he was greatly esteemed
and finally knighted. In 1195 he was called to the court of the King
of Spain and Morocco, in Cordova, where he received the highest honors,
only, however, through some misunderstanding, to be disgraced; but he
soon afterward recovered his former position and dignities. He wrote
extensively not only on medicine, but on philosophy, his writings taking
throughout a more or less dialectic character. He died in 1198, and
from him descended a number of physicians who achieved more or less
reputation.
_Maimonides_ was born in Cordova, A.D. 1135. He early devoted himself
to the Talmud, and in his extended travels visited Jerusalem; he even
founded a school of philosophy in the East, which, however, had only a
brief existence. He died in 1204. He ranked higher in philosophy than
in medical art, and seems to have been imbued with the methods of his
teacher, Averroës, and is generally regarded as a theorist rather than
as a practical physician, although he wrote more or less on medical
topics, and is particularly remembered for an essay upon poisons. He was
about the last of the Arabians who deserves special mention.
During the period which was nearing its close at the time of the death
of Maimonides, the Arabs embraced with much ardor the study of medicine,
and translated into their language nearly all the treasures that had
been amassed by the Greeks; indeed, the preservation of many of the
great writings which would otherwise have been lost is due solely
to this fact. Strange to say, however, the Arabians neglected Latin
authors, and apparently possessed no knowledge of Celsus or Coelius
Aurelianus. As religious prejudices prohibited dissections, they were
obliged{066} to rely solely upon the anatomical descriptions of Galen,
and succeeded in increasing the errors of the original by inaccurate
translations. So far as originality of observation goes, the Arabians
were in most respects behind the Greeks; nevertheless, they were the
first to differentiate eruptive fevers, to which the latter paid little
or no attention. The Arabian school also supplied the knowledge of
purgatives, such as cassia and manna, which replaced the drastics
employed by the ancients; also the mode of preparation of syrups,
tinctures, distilled waters, pomades, and plasters.
While the Arabians were gradually rising by their power, intelligence,
and renown, the Greeks were declining in inverse ratio; the genius,
courage, and ancient virtues of the latter grew weaker and weaker, until
they seemed on the verge of extinction. In the medical history of these
centuries, in all Europe not under Moslem rule, there was but one man
entitled to mention as an author in medicine,--viz., John Actuarius,
the son of one Zacharia. He lived at the close of the thirteenth and the
beginning of the fourteenth century; was employed at Constantinople,
his surname being the honorary title of the court-physicians. He is more
commonly known as Zacharia. Of his life we know little, save that he
wrote several volumes, for the most part abridgments or commentaries on
the doctrine of Galen. He laid great stress on the theory of critical
days, and sustained his views by astronomical hypotheses most
ingeniously combined. His was the first Greek work in which were
mentioned the remedies introduced by the Arabians, yet he has not a word
to say of variola, measles, spina ventosa, and other affections fully
described by Arabic authors. He held remarkable views concerning
the nature of man, whom he supposed to be formed by the union of
two contrary substances,--the soul and the body; described somewhat
elaborately an imaginary plexus of veins connected with the
digestive{067} organs, through which the animal spirits were elaborated
and purified; also, and quite methodically, for his age, he explained
the functions of the animal economy and the etiology of disease.
While the clouds that befogged the study of medicine in the Empire of
the East thus grew heavier and heavier, we must not be blind to the
melancholy spectacle concerning the provinces composing the Empire
of the West. Barbarians in swarms, from the forests of Germany and
Scandinavia, had swept its various portions, pillaging, destroying, and
reducing to slavery its inhabitants. In southern Europe everything was
changed. Each generation witnessed some new and unheard-of invader, who
demanded his share of booty and renown and left a track of desolation
behind him. There was a brief period of order when Charlemagne reunited
under one dominion these divers races and seemed to have resuscitated
the Western Empire; but no sooner was he dead than its elements, being
devoid of affinity, broke apart. Former vassals, no longer restrained by
the firm hand of the emperor, made common warfare against his successors
and against each other, and for several ages there was nothing but a
succession of wars and invasions. Feudalism gave some sort of character
to this military anarchy by affording repose and, in a measure, security
for those who had hitherto been trampled under foot; but learning
and the sciences fell into complete neglect, and it was with great
difficulty that a very small number of men found within the pale of the
church a limited protection that enabled them to devote themselves
to the study of medicine and ecclesiastical law. Near the end of the
eleventh century, however, the enthusiasm of the crusades whetted anew
the turbulent appetite of the Christian barons, and led these lords of
western Europe, with their belligerent spirits, to the East, as a result
of which people hitherto oppressed could breathe more freely. A few
States recovered their{068} independence; some semblance of law was
established; municipal institutions were organized, and establishments
consecrated to public use were founded and multiplied; finally, in
the course of the thirteenth and fourteenth centuries, the cloud which
covered the face of Roman Catholic Europe was in some measure dispersed,
and men of talent and even genius began to appear upon the scene;
everything about them being so obscure, they shone like stars in
the firmament. In letters, for instance, there were Dante, Petrarch,
Boccaccio; in mathematics, Leonard, of Pisa, the first in Europe to
understand and employ figures and algebraic characters, although Cuvier
has claimed this distinction for Gerbert, a Benedictine monk of the
tenth century, who subsequently became Pope Sylvester II. At this time,
although in scholastic estimation medicine, theology, and philosophy
alone were fit to entertain the human mind, the natural sciences were
not without occasional representatives. Roger Bacon was three
centuries in advance of scientific reform, and endeavored to introduce
experimental philosophy, and so fully convinced some of his auditors
that they subscribed £2000 sterling to provide for the expense of
his experiments; this was money most happily employed, since it made
possible a number of important discoveries. It is said that Bacon
knew the properties of convex and concave lenses, and was the first to
conceive of the microscope and telescope; his astronomical knowledge led
him to demand a reform in the calendar, which Gregory XIII carried out
three centuries later; he had knowledge of gunpowder and its effects,
and was, in fact, the wizard of his day; but his boldness and
originality drew upon him the enmity of the church, by which he was
persecuted and finally condemned to imprisonment for life upon a diet of
bread and water, although he was ultimately released, in 1266, by Pope
Clement IV. He wrote extensively, but only fragments of his works
exist, since the friars believed{069} them tainted with witchcraft and
prevented their publication.
Before and during the time of Roger Bacon the philosophers were divided
into two parties, which engaged in very unseemly and unphilosophic
strife. One was termed the _Realist_, and believed, with Plato, that
ideas are self-existent and independent of the mind,--in other words,
veritable entities; the other, the _Nominalist_, held, with Aristotle,
that general ideas are pure abstractions formed by the mind with the
aid of sensations received from without, without which they could never
exist,--that is, if a being could be imagined without sensibilities and
the power of sensation, such being would be destitute of ideas. These
two parties kept up a very active warfare, and enlisted the aid of both
civil and ecclesiastical authorities, the result being persecution of
each other, and that general unsatisfactory conflict into which theology
and metaphysical speculation always force those who indulge in them.
Now, regarding the condition of medical affairs in the Empire of the
West: Down to the seventh century, in Rome, there were court-archiaters
who were attached to the retinues of the nobles, and in each large city
popular archiaters formed a college charged with sanitary matters, the
instruction and examination of candidates, and gratuitous services to
the poor. Although there is little definite information available, it
is probable that after the ruin of Alexandria much the same medical
organization obtained in those provinces as continued under the Greek
Empire at Constantinople. Under Arab sway we know very little of what
rules or regulations governed instruction in medicine and its practice;
and, so soon as one of these countries fell under the rule of the
Turks, all scientific institutions seem to have decayed or been
discontinued,--or, as Renouard states it: "If we may judge by what still
exists to-day in this unfortunate country (Turkey), consumed by the
power of ignorance{070} and despotism, the most complete anarchy
followed all older organizations."
In southern Europe, however, things had not gone on quite so badly,
although at first barbarous invasion caused everywhere disorder and
confusion, and the Christian States of the Western Empire yet presented
after three or four centuries a chaotic condition of affairs. The
ecclesiastical schools, which were under the care of the church, still
pursued courses of literary and scientific instruction; in the time of
Charlemagne, for instance, the colleges of the cathedrals, and even some
of the monasteries, taught medicine in a very limited way under the
name of physics. Thus all the liberal professions--that of medicine
included--fell under the domination of the clergy, and priests, abbots,
and bishops became court-physicians. The monks of Mount Cassin, of the
order of St. Benoit, enjoyed for a long time a great reputation for
medical skill; and among these in the tenth century was an abbot named
Berthier Didier, who became Pope Victor III toward the close of the
eleventh century, and one Constantine, surnamed the African. Of
the ecclesiastics who from the ninth to the eleventh century were
distinguished by the knowledge of medicine, there were Hugues, abbot
of St. Denis, physician to the King of France; Didon, abbot of Sens;
Sigoal, abbot of Epernay; Archbishop Milo, etc. Even several religious
orders of women undertook, to a certain extent, the practice of
medicine, and Hildegarde, who was abbess of the convent of Rupertsburg,
near Bingen, is credited with having written a treatise on _Materia
Medica_.
From the ninth to the thirteenth century the Jews shared with the clergy
the monopoly of the healing art. Many of these studied under Arabian
physicians, and, though the canons of the church forbade them to in any
way minister to the ailments of Christians, they were still called upon
in time of need, and even in many instances had access to the palaces of
archbishops, cardinals, and popes.
The education{071} of Christian priests and infidel practitioners
embraced really very little, and consisted, for the most part, of
knowledge of a few symptoms and possession of a few receipts; books were
excessively rare and expensive, capable teachers lacking, and a good
medical education out of the question. There was no law nor public
regulation which concerned the practice of medicine, and any who desired
could enter upon it; while besides the priests and the Jews--which
latter stood at the top of the scale--there was a multitude of
charlatans of the lowest order, such as barbers, keepers of baths, and
even a few women. The morality of this vulgar herd was on a level with
its knowledge. I have said the practice of medicine was not regulated
by law, yet Theodoric, King of the Visigoths, enacted a statute that no
physician should bleed a woman of noble birth without the assistance
of a relative or domestic; that if a physician in treating a patient or
dressing a wound happened to harm a gentleman he should pay a forfeit of
one hundred sous, and if the patient died from the operation he should
be handed over to the relatives of the deceased, who could do with him
whatever they pleased; while if he crippled or caused the death of a
serf, he was to be held accountable only for the loss, and compelled
to supply another. This remained in force from the sixth to the twelfth
century, and was made to apply chiefly to the practice of surgery, which
had been abandoned to individuals of the lowest condition. The practice
of internal medicine was, for the principal part, the privilege of the
clergy, and it is not likely the secular power ever expected that
one protected with the title of priest should be handed over to the
relatives of the dead. It furthermore appears that the practice of
medicine as divorced from surgery led to such irregularities in the
manners and conduct of the clergy that from the twelfth century popes
and councils of the church repeatedly forbade the medical art to those
in holy orders or under vows; but that this prohibition{072} was often
violated is shown by the frequent reiteration of inhibitory laws. During
the twelfth century the secular authority was also affected by abuses.
Roger, founder of the kingdom of Sicily, one of the first Christian
princes of the Middle Ages, gave special attention thereto, and in 1140
proclaimed that every one who wished to practice medicine must present
himself before a magistrate and obtain authorization, under pain of
imprisonment and confiscation of goods. Other sovereigns followed this
example, and regulating ordinances were gradually established, which
ultimately led to the institution of medical faculties and university
degrees.
During the Middle Ages, in the Empire of the West, arose the School of
Salernum, which became so celebrated that, like that of Alexandria, it
deserves special mention. The modern city of Salerno is situated on the
Neapolitan Gulf, about thirty miles southeast of the city of Naples,
with a population of but a few thousand souls. The ancient city stood
upon a height in the rear of the present town, where the ruins of its
mediaeval citadel are still to be seen. It first appeared in history
194 B.C., when a Roman colony was founded, was a municipal town of
importance, and appears even at this early day to have been a health
resort, since Horace informs us he had been advised to substitute
its cool baths for the warm ones of Baiæ. During the stormy centuries
following the downfall of the Western Empire, Salerno successively
submitted to the sway of the Goths, Lombards, Franks, Saracens, and
Greeks, as the vicissitudes of Avar compelled. Under the Lombards it
became the residence of the Duke of Benevcntum, and, in 1075, when
taken by Robert Guiscard of Normandy, it fell to the crown of Naples,
in consequence of which in the fourteenth century, the heir apparent of
this kingdom took the title of Prince of Salernum.
During the Middle Ages here flourished a medical school, important not
alone because of its celebrity at the time, but{073} for its effect upon
the medical history of the future. Its origin is obscure, though it has
been ascribed to Charlemagne in 802; again, its founding has been held
to be the work of fugitives from Alexandria when that city was captured
by the Saracens, 640 A.D.; some attribute it to the Benedictine order of
monks, others to Saracens, etc. The foundation by Alexandrian fugitives
is probably conjectural, yet it must be admitted there is some evidence
of knowledge of Arabian medicine in Salernum as early as this. Be the
origin what it may, it is certain that the Benedictine monks exercised
a very important influence upon this school, and there is considerable
reason to think that it was really originated by them. Their monastery
of Monte Casino was located about fifty miles the other side of Naples,
occupying the site of an ancient temple of Apollo; the rules of the
order enjoined the care of the sick and treatment by prayer, and St.
Benedict himself was credited with performing miraculous cures. The
rules which forbade public instruction were gradually discarded, for
in the ninth century Abbot Bertharius wrote two books on the art of
healing, and by the tenth century Monte Casino had acquired great
reputation as a medical school, and was sought by medically-inclined
monks from all quarters. A little later (1022) King Henry II, of
Bavaria, Emperor of Germany, is said to have been cut for stone by St.
Benedict himself, who appeared in ghostly form and operated with such
skill that on awaking the royal patient found the calculus in his hand,
and only the cicatrix of the wound through which it had been removed.
Of course, the grateful emperor could do no less than richly endow the
monastery, and bestow upon it additional privileges.
Desiderius, the Benedictine abbot from 1058 to 1086, and in the eleventh
century promoted to the papal chair under the title of Victor III, was
distinguished for his attainments in medicine and in music, and founded
a new hospital in connection with the monastery; he also composed
four{074} books detailing the miraculous cures wrought by his patron
saint. It was really within this monastery that Constantine the African,
one of the most learned men and the most famous Christian physician of
his time, compiled his numerous medical treatises.
About Constantine there is much of romance. He was born in Carthage in
1018 and died in 1085. He visited all the prominent schools of his day
in Egypt, Bagdad, Babylon, and even India, and for thirty-nine years
pursued the various branches of knowledge away from home. Returning to
Carthage, misunderstood and feared, he was accused of practicing sorcery
and compelled to fly to save his life. Disguised as a beggar he escaped
to Salernum, which had been recently captured by Robert Guiscard, and on
the recommendation of some royal visitor, who had known him at another
court, he was made private secretary to Guiscard. His new duties soon
became irkscme, however, and he retired to a cloister to devote himself
to literary labors. These, for the most part, were translations of Greek
and Arabic writings, often made _verbatim_ and without credit. Whatever
may be said about this lack of honesty, and the barbaric nature of his
Latin, credit must be given him for reviving the study of Hippocrates
and Galen in France; and he is generally credited with being the first
to introduce into Europe knowledge of Arabian medicine.
From Monte Casino the Benedictines at an early day spread to Salernum,
where, by the middle of the tenth century, three monasteries were
established, in all of which were kept holy relics. It now appears that,
although there may have been some previous institution of learning at
this point, and possibly even medical teachers, the real organization of
a regular school of medicine was due to the Benedictines. In the annals
of Naples of the middle of the ninth century the names of Salernian
physicians are mentioned; and it is known that toward the close of the
tenth century{075} Archbishop Verdun visited Salernum for relief from
vesical calculus, and there died.
The earliest medical writings of this school which have been preserved
are found in the _Compendium Salernitanum_, discovered in manuscript
form in 1837; and among the more prominent authors quoted are:
Petronius, who wrote about 1035; Gariopontus, who wrote about 1040;
Bartholomæus, Ferrarius, and Affiacius,--the latter a disciple of
Constantius Africanus.
The preaching of Peter the Hermit, which marked the close of the
eleventh century, was followed by an outburst of crusading enthusiasm
that quickly converted Europe into a vast camp, and Salernum, being
situated upon the highroad to the East, was benefited in no small degree
and its reputation as a medical school materially enhanced; likewise its
teachers gained in experience as regards military surgery. In this way
it became a favorite resort for crusaders when disabled, wounded, or
diseased. Robert of Normandy, son of the conqueror, returning from the
Holy Land, remained here for some time with a poisoned wound in the arm,
received in 1097 at the siege of Jerusalem, and it was decided it could
be healed only by sucking out the poison, a process deemed dangerous to
the operator. History declares that Robert's wife, daughter of Goeffrey,
Earl of Conversana, being denied permission, took advantage of her
husband's unconsciousness during sleep to withdraw the poison, when the
wound speedily healed. At the time of the departure of Robert, hastened
by the death of his brother William, John of Milan, the then chief of
the medical school, presented him with the famous _Regimen Sanitatis
Salerni_, said to have been composed largely for Robert's benefit.
This was a Latin poem that enjoyed most unexampled popularity for many
generations, and was the _vade mecum_ of well-educated physicians for
centuries. It is said to have passed through two hundred and forty
different editions, and that more than one hundred manuscript{076}
copies are to-day to be found in various European libraries. The latest
English version was published by Professor Ordronaux in 1871. A sample
is here submitted:--
"Salerno's school in conclave high unites
To counsel England's king, and thus indites:
If thou to health and vigor would'st attain,
Shun mighty cares; all anger deem profane;
From heavy suppers and much wine abstain;
Nor trivial count it after pompous fare
To rise from table and to take the air.
Shun idle noonday slumbers, nor delay
The urgent calls of nature to obey.
These rules if thou wilt follow to the end,
Thy life to greater length thou may'st extend."
During the twelfth and thirteenth centuries the glory of the School of
Salerno reached its zenith; it was the most famous school of medicine in
Europe, and was fostered by various kings. The celebrated Jew, Benjamin
of Tudela, traveling from Spain to India, visited Salernum in 1164, and
called it the "principal university of Christendom." Early in the
twelfth century flourished Cophon, Archimatheus, and Nicholas, surnamed
Præpositus, all of whom were distinguished teachers. The latter
published a work known as _Antidotarium_, which was for several
centuries the standard pharmacopoeia, and which contained a table
of weights that corresponded very closely to those of the modern
apothecary. The younger Cophon, who has been confounded with his father
(as both seem to have written extensively), wrote two treatises,--one on
the anatomy of the hog, the other entitled _Ars Medendi_. The first is
interesting as the only anatomical treatise of this school which has
been preserved, and is an index of the degradation of anatomical science
of that time.
The names of John and Matthew Platearius are of frequent occurrence
in the records of this school, and have given rise to considerable
confusion; the former is supposed to have{077} been the husband of
Trotula, a female physician, of whom I shall have more to say later.
Bernard the Provincial, who seems to have escaped the notice of most
historians, wrote about 1155, and his commentary offers much interesting
information concerning the therapeutics of the day; he formulated a
large number of recipes to enable the sick to escape the omnipotence of
the apothecaries, and recommended wine for the delicate stomachs of the
more exalted of the clergy, and, inasmuch as these stomachs did not
bear medicine well, he directed, in accordance with the practice of
Archbishop Æfanus, that emetics should be prescribed _after_ meals, when
their action is less injurious and more agreeable; he advised young men
and women tormented with love which they could not gratify to tie
their hands behind their backs and drink water from a vessel in which
a red-hot iron had been cooled. Indeed, his work is full of curious
information and advice, and is not without therapeutic interest.
A name which figures largely in the history of this school is that of
Magister Salernus, about which there is great uncertainty; it is not
positively known whether this refers to a particular person or is a
generic name covering various individuals. The name has been mentioned
as that of one of the four reputed founders of the school; it is
positive that there are certain treatises which bear this name, which
give an appearance of authenticity to it as an individual title.
In the latter half of the twelfth century lived John of St. Paul, one
of the teachers of Gilbert the Englishman; also Musandinus, who left a
curious treatise on dietetics; and Urso, who wrote on the pulse and on
the urine. Here in 1190 resided and studied a certain Alcadinus, from
Syracuse, whose knowledge of philosophy and medicine was such that he
acquired great reputation, and was made a professor; he even composed
Latin medical poems.
Just at the close of this century flourished Ægidius, who studied{078}
at Salernum, and also at Montpellier, where a school of medicine had
been founded in 1180; he was physician to Philip Augustus, of France,
and became professor in the University of Paris. Three treatises, all
in Latin hexameter, are ascribed to him. A contemporary was Johanes
Rogerus, of Palermo, a graduate of Salernum and author of several
works.
Early in the thirteenth century flourished Roger of Parma, one of the
most distinguished of the alumni of this school and the earliest
pioneer in modern surgery; his work on this topic, familiarly known as
_Rogeriana_, enjoyed the greatest reputation in its day, and was for
a long time the surgical text-book of Italy; his predilection for
poultices and moist dressings in the treatment of wounds, abscesses,
and ulcers became, in the hands of his successors, the distinguishing
feature of the surgery of Salernum in opposition to the school at
Bologna, where Hugo Di Lucca and Theo-doric (his great rival) contended
for the superiority of the dry treatment. Roger was also the first to
use the term _seton_, and to give practical demonstration to this means
of derivation.
Roland of Parma, a pupil of Roger, and a surgeon of great distinction,
became professor at Bologna, and wrote a treatise on surgery, which was,
for the most part, a commentary on the works of his master. The treatise
of Roger and that of Roland furnished the basis for a work entitled _The
Treatise of the Four Masters_, supposed to have been written about
1270, and manuscripts of which have been long known in various European
libraries. It is divided into four books, displays no little surgical
ability, and from its title would appear to have been the joint
composition of four teachers; indeed, it was long attributed to
Archimatheus, Platearius, Petro Cellus, and Affiacius, though it is now
pretty generally understood to be the product of but a single pen and
its author most likely a Frenchman. The ascription of authorship to four
masters was probably for the purpose{079} of increasing its weight and
authority, and it constituted a reliable exposition of the surgery of
Salernum in its day. It is quoted quite freely by Guy de Chauliac,
who was the restorer of French surgery in the fourteenth century, and
occasionally by later writers.
Another of the distinguished Salernian physicians of the thirteenth
century, one highly esteemed by Frederick II, was John of Procida, who
also was active in producing--if not the real author of--the massacre of
the Sicilian Vespers, A.D. 1282. In a dispute concerning the question of
the two Sicilies he embraced the cause of Prince Manfred, for which he
was banished by Charles of Anjou, and took refuge at the court of Peter
III, of Arragon, by whom he was created a baron; and he was influential
in persuading the latter to assert his claim to the throne of Sicily.
By various intrigues at different courts he succeeded in organizing an
alliance, which betrayed its existence in this massacre, and finally
resulted in the overthrow of the French in Sicily and the transfer
of the island to the crown of Spain. He was author of at least two
treatises devoted to medicine and philosophy.
Other writers of the School of Salernum were: a learned Jew of
Agrigentum known as "Farragus," Matthew Sylvaticus, Graphæus, and
Cappola. About the middle of the fifteenth century flourished Saladino,
famous as an authority on materia medica.
It is of no small interest that now, for the first time in history,
women began to figure somewhat prominently as writers, practitioners,
and even teachers of medicine. About the middle of the eleventh century
appeared a work, entitled _De Midierium Passionibus_, attributed to the
before-mentioned Trotula, wife of John Platearius, which has descended
even to these days. There is nothing in the work to indicate the name
or sex of the author, who is invariably spoken of in the third person;
consequently Trotula's connection therewith has often been disputed.
It mentions{080} a certain "_aqua mirabilis_" composed largely of
brandy, which spirit is said to have first been employed medicinally by
Thaddeus of Florence, who died in 1295; there is also an account of a
patient who _wore spectacles!_ The diseases of women and children are
also largely dealt with. The work is undoubtedly an anonymous production
of the eleventh century, disfigured by additions of a later day, and
ascribed to Trotula, perhaps, because of the celebrity that attached
to her; at all events, it is the earliest work ascribed to a female
physician, and thus possesses special claims to interest.
Later we read of Sichelguada, wife of Robert Guiscard and a graduate of
Salernum, who endeavored to poison her step-son, Bohemond, in order to
secure the succession of her own child. This infamous plot was furthered
by some of the Salernian physicians, and thwarted only by the prompt
action of Guiscard, who swore he would slay his wife with his own sword
should the malady of Bohemond prove fatal.
Certain other female physicians of this period are mentioned, notably
Abella, who, in spite of the modesty that is supposed to hedge about
her sex, produced in Latin hexameter a work entitled _De Natura Seminis
Hominis_. Mercuriolus, in the fifteenth century, produced treatises
on the cure of wounds, pestilent fevers, and on the nails. The most
celebrated of all, however, appears to have been Calenda, who lived
during the reign of that notorious profligate, John II, of Naples
(1414-1435), and who was particularly distinguished for her personal
attractions. She graduated with great honor from the school at Salernum,
and soon after, in 1423, married a nobleman of the court, which
perhaps accounts for the fact that she never exercised the privilege
of authorship. A little later, Marguerite, of Sicily or Naples, also a
Salernian graduate, acquired an extended professional reputation, and
was licensed to-practice by Ladislaus, King of Poland.
Daremberg{081} informs us that there were numerous female physicians
at Salernum, much sought after because of their talents, and, moreover,
highly esteemed by the professors of the school, who freely quoted the
writings of their fair pupils and contemporaries; further, that they
employed ointments in paralyses; fumigations, vapors, and antimony for
coughs; and lotions of aloe and rose-water for swellings of the face;
they combined scientific knowledge with facetious playfulness in a
manner peculiar to the sex, in that they tendered unsuspecting beaux
bouquets of roses doctored with powdered euphorbium, and hugely enjoyed
the forced sternutations of their victims.
It will thus be seen what a wide-spread and long-continued influence
the school of Salernum exerted. At first physics and philosophy were the
principal branches taught, but later the other sciences were cultivated.
The Emperor Frederick II united the different schools of the city into
a university,--a term, however, that, as then applied, appears to
have corresponded to what in the nineteenth century is understood by
_corporation_. The emperor likewise published several decrees which
revised the duties and privileges of practitioners of medicine and
surgery in his kingdom, and, in 1224, ordered that no person should
practice within the two Sicilies until examined by the faculty of the
university and licensed at the royal hands; further, practitioners
were compelled to devote at least one year to the study of anatomy. The
faculty at this time consisted of ten professors, whose salary probably
depended upon the number of pupils. A candidate for graduation was
required to present proof of majority, of legitimacy of birth, and of
proper duration of preliminary study, and then was examined publicly in
the _Synopsis_ of Galen, the _Aphorisms_ of Hippocrates, or the Canon of
Avicenna. On passing he swore to conform to all the regulations hitherto
observed in medicine, to give gratuitous treatment to the poor, and to
expose all apothecaries detected{082} in adulterating drugs. A book was
then placed in his hands, a ring upon his finger, and a laurel crown
upon his head, when he was "dismissed with a kiss." The degree conferred
was that of "_Magister_"--the modern title of Doctor being at that
period employed almost exclusively to designate a public teacher or
professor.
But the watchfulness of King Frederick was not confined alone to
the regulation of medical study within his kingdom. The number of
professional visits, and the recompense therefor, were fixed by law.
Every physician was compelled to visit his patients twice daily, and
even once at night as well, if summoned, and for this attendance was
permitted a daily fee equivalent to fourteen cents for patients within
the city, while for calls without the city the largest legal charge was
one dollar and thirteen cents, provided he paid his own expenses.
The earlier teachings and practice of Salernum were a curious mixture
of methodism, dogmatism, and superstition. The latter may be better
understood when it is recalled that the practice of medicine for an
extended period was confined almost exclusively to ecclesiastics, who by
their very education were prone to superstition and upheld the efficacy
of charms and relics, and the active intervention of saints and martyrs
as well as the myrmidons of evil; hence arose many of the conflicts and
absurd notions peculiar to the period. The prevalence of the doctrine
of medical methodism was due to the character of the writings most
accessible to students of that day,--such as those of Ccelius Aurelianus
and others; and it is curious that Celsus, the most elegant of medical
authors, was never popular among medical monks. The Hellenic language
having almost disappeared from Italy by the sixth century, the works of
the Greek authors had become a sealed book to a vast majority, even of
the better educated; hence the purer sources of medical knowledge
were not available. Although the school of Salernum, at a later date,
prided{083} itself upon its devotion to the "Father of Medicine,"
the Hippocratic writings were not known at this period; and, when
Constantine the African, by the translation of Arabian works, introduced
a new element into the Salernian school, he ingrafted upon its medical
teaching a form of doctrine which found a congenial atmosphere, in which
it throve vigorously, while, a century later, the translations of Gerard
of Cremona gave a stronger impulse to the growth of Hippocratic medicine
than to Hippocratic doctrine.
From the _Commentary of the Four Masters_ we learn that Salernian
practitioners recognized the diagnostic importance of nausea, vomiting,
and the flow of blood from the ears in injuries to the head; that
they resorted to the trepan for depressed fractures and the relief of
intracranial extravasation; that hernia cerebri was treated by pressure
and caustics; that ligatures, both above and below the opening, were
applied for the treatment of wounds of the carotid arteries and jugular
veins. It was advised to decline patients suffering from wounds of
the heart, lungs, diaphragm, stomach, or liver, in order to avoid the
disgrace of losing them; and in penetrating wounds of the intestines and
in those complicated with protrusion of the wounded gut instruction was
given how to envelop them in the warm abdomen of a slaughtered animal
until natural color and temperature were restored, and then to insert a
cannula of alder-wood into the wounded intestine, which was to be neatly
closed and stitched; finally, the protrusion was to be carefully washed
with warm water and returned into the abdominal cavity, enlarging the
opening for this purpose, if necessary. Also was advised the extraction
of diseased teeth; and the operation of lithotomy was described with
considerable care. Compound fractures were to be treated with splints.
On the whole, this commentary of the alleged Four Masters is the most
interesting and ancient Salernian work which has been{084} preserved,
and is well worthy the attention of even modern surgeons.
Such was the school of Salernum in its prime, during the twelfth and
thirteenth centuries. My readers will not have failed to note how few
names have been mentioned which are prominent in medical history, and
how few improvements were made in medical art by those who have been
mentioned. One naturally inquires, then, what was the source of the
wide-spread fame of Salerno as a school, since it was distinguished
neither by notable discovery in science nor by celebrated teachers, and
the predominant element was doubtless one of obstinate conservatism and
unswerving devotion to ancient doctrines. Founded during the dark period
of the Middle Ages, at a time when ignorance, bigotry, and superstition
prevailed, it preserved, amidst the gloom that had settled upon Europe,
a few rays of that intellectual light which had shown so brightly in the
golden ages of Roman history. These rays, made more conspicuous by the
intellectual night which they barely illumined, were a beacon for
men who were groping for more light. Thus the name of Salernum became
synonymous with intellectual advancement in later ages. As the parent
and model of our modern university system, Salernum yet deserves, in a
measure, to enjoy the esteem of a numerous scholastic offspring. At a
time when priests were particularly active in passing off rudimentary
knowledge for the science of healing this school began to secure all
information possible from the laity for the progressive development of
medicine. It began, in other words, to hold aloof and then to break away
from the fetters of a fanatical church. Its decline, too, was as rapid
as its career had been brilliant. One very serious blow was struck
when, in 1224, Frederick II founded the University of Naples and forbade
Neapolitan subjects to seek instruction at any other university. The
next year a revolt in the city provoked the closure of the schools{085}
of Bologna, which were, however, opened again two years later. Within
a short time the universities of Naples, Montpellier, Padua, Paris, and
Bologna all entered into a contest for pre-eminence with a rivalry which
was not always generous. In 1224, it is said, the latter university had
no less than ten thousand students. Happily, however, the period of
the Renaissance proved to be one of emancipation from the fetters of
ignorance and superstition, making an appeal for liberty which the
conservatism of Salernum could not brook. Roger Bacon, in England;
Lanfranc and Guy de Chauliac, in France; Mondino, at Bologna, and
Savonarola, at Padua, found no rivals at Salernum to successfully
contest their fame. Thus this ancient school fell behind the age, and in
a short time sank into a mediocrity which was scarcely brightened by the
reflection of a departed glory. In 1342 Robert I renewed the decree of
Frederick II, which closed all the schools in his kingdom save those of
Naples, but excepted Salernum solely because of its antiquity and the
traditions of his predecessors. In 1413 King Ladislaus excepted the
Salernian alumni and professors from all taxes, duties, and tribute.
In the middle of the fourteenth century the poet Petrarch speaks of the
school as a memory of the past; but its last appearance was in 1748,
when a dispute at Paris relating to the rank of physicians and surgeons
was referred to Salerno's university for arbitration and final decision.
In 1811 a formal decree reduced this parent of all European universities
to a mere gymnasium or preparatory school; and now one may wander
through the streets of the modern town and among the ruins of its
ancient predecessor and seek in vain to trace some reminder of those who
were illustrious during some of the most terrible ages in the world's
history. No echo of tradition, no stone of ancient edifice, no library
preserving precious manuscripts, not even an edition of the old
Salernian regimen, in the whole city; in fact, none now so poor as to do
it reverence.