Medieval Medicine. James Joseph Walsh
which, on proper examination, he might be given the degree of doctor—that is, teacher of medicine; but he must spend a further year of practice with a physician before he would be allowed to practise for himself.
This is such a high standard that, only that we have the actual wording of the law, it would seem almost impossible that it could have been evolved at this period in medical history. It actually represents the standard that we have climbed back to generally only during the past generation or two, and in the interval there have been many rather serious derogations from it. This law of the Emperor Frederick is, moreover, a pure drug law, regulating the sale of drugs and their purity, and inflicting condign punishment for substitution; in this regard also anticipating our most recent well-considered legislation. The penalty by which the druggist was fined all his movable goods for substitution, while the government inspector who permitted such substitution was put to death, would seem to us in the modern time to make the punishment eminently fit the crime. Almost needless to say, then, the law (see Appendix for full text) represents one of the most important documents in the history of medicine, particularly of medical education. The fee regulation included in it shows that medicine was looked upon as a profession, and was paid accordingly.
From Salerno come many of the traditions of the conferring of degrees which are still used in a large number of modern medical schools. Before receiving his degree, the candidate had to take an oath, of which the following were the principal tenets: “Not to contradict the teaching of his college, not to teach what was false or lying, and not to receive fees from the poor even though they were offered; to commend the sacrament of penance to his patients, to make no dishonest agreement with the druggists, to administer no abortifacient drug to the pregnant, and to prescribe no medicament that was poisonous to human bodies.”
It has sometimes been said that youths of tender age were admitted to the study of medicine at Salerno, and that many of them were given their degrees at the age of twenty-one. De Renzi’s discussion would seem to show that the usual age of receiving the degree was twenty-five to twenty-seven. As medical students had to have three years of preparatory studies in literature and philosophy, it would seem that they must have been rather mature on their admission to the medical schools.
De Renzi tells us that the medical school of Salerno was of great importance not only for medical education, but it acquired sufficient means to extend its benefits over the entire city. Gifts were made of statues to the churches, and especially to the shrine of St. Matthew the Apostle, situated here; monuments were set up, inscriptions placed and ample donations made to the various institutions of the city. The formal name of the medical school was Almum et Hippocraticum Medicorum Collegium. This is the first use that I know of the word almum in connection with a college, and may very well be the distant source of our term alma mater. The medical school was situated in the midst of an elevated valley which opened up on the mountain that dominates Salerno, and while enjoying very pure air must have been scarcely disturbed at all by the winds which can be blustery enough from the gulf. De Renzi says that in his time some of the remains could still be seen, though visitors to Salerno now come away very much disappointed because nothing of interest is left.
The most famous of the teachers at Salerno was Constantine Africanus, so called because he was born near Carthage. His life runs from the early part of the eleventh century to near its close, and he lived probably well beyond eighty years of age. Having studied medicine in his native town, he wandered through the East, became familiar with a number of Oriental languages, and studied the Arabian literature of science, and above all of medicine, very diligently. The Arabs, owing to their intimate contact with the Greeks in Asia Minor, had the Greek authors constantly before them, and Hippocrates and Galen have always roused men to do good work in medicine. Constantine seems not to have learned Greek, finding enough to satisfy him in the Arabic commentaries on the Greek authors, and probably confident, as all young men have ever been, that what his own time was doing must represent an advance over the Greek. He brought back with him Arabian books and a thorough knowledge of Arabian medicine. When he settled down in Carthage he was accused of magical practices, his medical colleagues being apparently jealous of his success—at least, there is a tradition to that effect to account for his removal to Salerno, though the immediate reason seems to have been that his reputation attracted the attention of Duke Robert of Salerno, who invited him to become his physician.
After Constantine’s time the principal textbooks of the school became, according to De Renzi, Hippocrates, Galen, and Avicenna. To these were added the Antidotarium of Mesue, and there were various compendiums of medical knowledge, quite as in our own time—one well known under the name of Articella. In surgery the principal textbook was the surgical works of the Four Masters of Salerno, which interestingly enough was the sort of combination work gathered from a series of masters that we are accustomed to see so frequently at the present day. De Renzi insists that there was much less Arabic influence at Salerno than is usually thought; and Gurlt more recently has emphasized, as we have said, the fact that the great textbooks of surgery which we have from Salerno contain not Arabisms, as might be expected from the traditions of Arabic influence that we hear so much of, but Græcisms, which show that here at Salerno there was a very early Renaissance, and the influence of Greek writers was felt even in the twelfth century.
Probably the best way to convey in brief form a good idea of the teaching in medicine at Salerno is to quote the Regimen Sanitatis Salernitanum, the Code of Health of the School of Salernum, which for many centuries was popular in Europe, and was issued in many editions even after the invention of printing. Professor Ordronaux, Professor of Medical Jurisprudence in the law school of Columbia College (now Columbia University, New York), issued a translation of it in verse,3 which gives a very good notion of the contents and the spirit and the mode of expression of the little volume.
The Regimen was written in the rhymed verses which were so familiar at this time. Many writers on the history of medicine have marvelled at this use of verse, but anyone who knows how many verse-makers there were in the twelfth and thirteenth centuries all over Europe will not be surprised. It used to be the custom to make little of these rhymed Latin verses of the Middle Ages, but it may be well to recall that in recent years a great change has come over the appreciation of the world of literature in their regard. The rhymed Latin hymns of the Church, especially the Dies Iræ, the Stabat Mater, and others, are now looked upon as representing some of the greatest poetry that ever was written. Professor Saintsbury of the University of Edinburgh has declared them the most wondrous wedding of sense and sound that the world has ever known. The Regimen Sanitatis of Salerno is of course no such poetry, mainly because its subject was commonplace and it could not rise to poetic heights. A good deal of the deprecation of its Latinity might well be spared, for most of the mistakes are undoubtedly due to copyists and interpolation. The verses not only rhyme at the end, but often there are internal sub-rhymes. This too was a very common custom among the hymn-writers, as the great sequence of Bernard of Morlaix, so well known through its translations in our time, as “Jerusalem the Golden” attests.
The Regimen was not written for physicians, but for popular information. It seems to have been a compilation of maxims of health from various professors of the Salernitan School. Nothing that I know shows more clearly the genuine knowledge of medicine, and the careful following of the first rule of medical practice non nocere to which Salerno had reached at this time, than the fact that this popular volume contained no recommendation of specific remedies, but only health rules for diet, air, exercise, and the like, many of which are as valuable in our time as they were in that, and very few of which have been entirely superseded—together with some general information as to simples, and a few details of medical knowledge that would give a convincing air to the compilation.
The book was dedicated to the King of the English, Anglorum regi scribit schola tota Salerni, and in the translation made by Professor Ordonaux begins as follows:
If thou to health and vigour wouldst attain,
Shun weighty 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
Philadelphia: Lippincott, 1871.