Medicine in Early Middle Ages: School of Salerno

In medical as in civil history there is no real break. A continuous thread of learning and practice must have connected the last period of Roman medicine already mentioned with the dawn of science in the Middle Ages. But the intellectual thread is naturally traced with greater difficulty than that which is the theme of civil history; and in periods such as that from the 5th to the 10th century in Europe it is almost lost. The chief homes of medical as of other learning in these disturbed times were the monasteries. Though the science was certainly not advanced by their labours, it was saved from total oblivion, and many ancient medical works were preserved either in Latin or vernacular versions. The "Anglo-Saxon Leechdoms" of the 11th century, published in the Master of the Rolls series of mediaeval chronicles and memorials, admirably illustrate the mixture of magic and superstition with the relics of ancient science which constituted monastic medicine. Similar works, in Latin or other languages, exists in manuscripts in all the great European libraries. It was among the Benedictines that the monastic study of medicine first received a new direction, and aimed at a higher standard. The study of Hippocrates, Galen, and other classics was recommended by Cassiodorus (6th century), and in the original mother-abbey of Monte Cassino medicine was studied; but there was not there what could be called a medical school; nor has this foundation any connexion (as has been supposed) with the famous school of Salerno.

The origin of this, the most important source of medical knowledge in Europe in the early Middle Ages, is involved in obscurity. It is known that Salerno, a Roman colony, is a situation noted in ancient times for its salubrity, was in the 6th century at least the seat of a bishopric, and at the end of the 7th century of a Benedictine monastery, and that some of the prelates and higher clergy were distinguished for learning, and even for medical acquirements. But it has by recent researchers been clearly established that the celebrated Schola Salernitana was a purely secular institution. All that can with certainty be said is that a school or collection of schools gradually grew up in which especially medicine, but also, in a subordinate degree, law and philosophy were taught. In the 9th century Salernitan physicians were already spoken of, and the city was known as Civitas Hippocratica. A little later we find great and royal personages resorting to Salerno for the restoration of their health, among whom was William of Normandy, afterwards the Conqueror. The number of students of medicine must at one time have been considerable, and in a corresponding degree the number of teachers. Among the latter many were married, and their wives and daughters appear also in the lists of professors. The most noted female professor was the celebrated Trotula in the 11th century. The Jewish element appears to have been important among the students, and possibly among the professors. The reputation of the school was great till the 12th or 13th century, when the introduction of the Arab medicine was gradually fatal to it. The foundation of the university of Naples, and the rise of Montpellier, also contributed to its decline.





The teachings of the Salernita doctors are pretty well known through existing works, some of which have only recently been discovered and published. The best-known is the anonymous rhyming Latin poem on health, Regimen Sanitatis Salerni, professedly written for the use of the "king of England," supposed to mean Robert, son of William the Conqueror; it had an immense reputation in the Middle Ages, and was afterwards many times printed, and translated into most European languages. This was a popular work intended for the laity; but there are others strictly professional. Among the writers it may be sufficient to mention here Gariopontus; Copho, who wrote the Anatome Porci, a well-known mediaeval book; Joannes Platearius, first of a family of physicians bearing the same name, whose Practica, or medical compendium, was afterwards several times printed; and Trotula, believed to be the wife of the last-named. All of these fall into the first period before the advent of Arabian medicine. In the transitional period, when the Arabian school began to influence European medicine, but before the Salernitans were superseded, comes Nicolaus Praepositus, who wrote the Antidotarium, a collection of formulae for compound medicines, which became the standard work on the subject, and the foundation of many later compilations. An equally popular writer was Gilles de Corbeil (Aegidius Corboliensis), at one time a teacher at Salerno, afterwards court physician to Philip Augustus of France, who composed several poems in Latin hexameters on medical subjects. Two of them, on the urine and the pulse respectively, attained the position of medical classics.

None of these Salernitan works rise much above the rank of compilations, being founded on Hippocrates, Galen, and later Greek writers, with an unmistakable mixture of the doctrines of the Methodists. But they often show much practical experience, and exhibit the naturalistic method of the Hippocratic school. The general plan of treatment is dietetic rather than pharmaceutical, though the art of preparing drugs had reached a high degree of complexity at Salerno. Anatomy was as little regarded as it was in the later ancient schools, the empiric and methodic, but demonstrations of the parts of the body were given on swine. Although it cannot be said that the science of medicine was advanced at Salerno, still its decline was arrested at a time when every other branch of learning was rapidly falling into decay and there can be no doubt that the observation of patients in hospitals, and probably clinical instruction, were made use in learning and teaching. The school of Salerno thus forms a bridge between the ancient and the modern medicine, more direct though less conspicuous than that circuitous route, through Byzantium, Baghdad, and Cordova, by which Hippocrates and Galen, in Arabian dress, again entered the European world. Though the glory of Salerno had departed, the school actually existed till it was finally dissolved by an edict of the emperor Napoleon I in the year 1811.





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