Roger, or Ruggiero, known as Roger of Parma or of Palermo, lived about 1210, was a student, and for a long time a professor in Salerno. He was a celebrated surgeon, who practised trepanning of the sternum and stitching of the intestine. He was the first to describe a case of hernia pulmonis, to use the term seton, and to prescribe the internal use of sea-sponge for the removal of bronchocele.[770] He knew how to arrest hæmorrhage by styptics, sutures, and ligatures.
He was the earliest special writer on surgery in Italy.[771] His later editor Rolando exhibits an acquaintance with surgery, which shows that, although the art had not been previously written upon in Italy, it was very well understood at Salerno. De Renzi says that some of the operations described are trephining, the removal of polypi from the nose, resection of the lower jaw, the operation for hernia and lithotomy. Malignant tumours of the rectum and uterus are referred to.[772]
Salerno was the first school in Europe in which regular diplomas in medicine were granted to students who had been duly instructed and had passed an examination in accordance with the requirements of the legal authorities. The great patron of Salerno, Frederick II., in the year 1240 confirmed the law of King Roger, passed in the year 1137, or as some say in 1140, with reference to licences to practise medicine. That ancient enactment was that, “Whoever from this time forth desires to practise medicine must present himself before our officials and judges, and be subject to their decision. Any one audacious enough to neglect this shall be punished by imprisonment and confiscation of goods. This decree has for its object the protection of the subjects of our kingdom from the dangers arising from the ignorance of practitioners.”[773]
Frederick’s law was: “Since it is possible for a man to understand medical science, only if he has previously learnt something of logic, we ordain that no one shall be permitted to study medicine until he has given his attention to logic for three years. After these three years he may, if he wishes, proceed to the study of medicine. In this study he must spend five years, during which period he must also acquire a knowledge of surgery, for this forms a part of medicine. After this, but not before, permission may be given him to practise, provided that he passes the examination prescribed by the authorities and at the same time produces a certificate showing that he has studied for the period required by the law.” “The teachers must, during this period of five years, expound in their lectures the genuine writings of Hippocrates and Galen on the theory and practice of medicine.” “But even when the prescribed five years of medical study are passed, the doctor should not forthwith practise on his own account, but, for a full year more he should habitually consult an older experienced practitioner in the exercise of his profession.”
“We decree that in future no one is to assume the title of doctor, to proceed to practise or to take medical charge, unless he has previously been found competent in the judgment of teachers at a public meeting in Salerno, has moreover by the testimony in writing of his teachers and of our officials approved himself before us or our representatives in respect of his worthiness and scientific maturity, and in pursuance of this course has received the state-licence to practise. Whoever transgresses this law, and ventures to practise without a licence, is subject to punishment by confiscation of property and imprisonment for a year.” “No surgeon shall be allowed to practise until he has submitted certificates in writing of the teachers of the faculty of medicine, that he has spent at least one year in the study of that part of medical science which gives skill in the practice of surgery, that in the colleges he has diligently and especially studied the anatomy of the human body, and is also thoroughly experienced in the way in which operations are successfully performed and healing is brought about afterwards.”[774]
For centuries after this barbers in other countries practised surgery without let or hindrance.
The doctor was bound to give advice to the poor gratis, and to inform against apothecaries who did not make up his prescriptions in accordance with the law. The doctor’s fee in the daytime within the town was half a gold tarenus; outside the city he could demand from three to four tareni, exclusive of his travelling expenses.[775] Doctors were not permitted to keep drug-shops. Apothecaries were obliged to compound the medicines in conformity with the doctor’s prescriptions, and the price they charged was regulated by law. Inspectors of drug-shops were appointed to visit and report. The punishment of death was imposed on the officials who neglected their duties.[776] These laws have served as the pattern for succeeding enactments for the regulation of medical education and practice.
In 1252 King Conrad created the school of Salerno a university, but King Manfred in 1258 by his restoration of Naples University left Salerno only its medical school.
On the 29th of November, 1811, a decree of the French Government put an end to the oldest school of medicine in Europe.
Daremberg concludes his admirable treatise on the school of Salerno with a pathetic account of a visit which he made to that city in 1849; he tells how he wandered through its streets, once so active with the movements of the students and professors of the medical sciences, and he laments that not a single remembrance of its illustrious masters remains to remind the visitor of its ancient glories. Not a stone of the edifices, not an echo of its traditions, not even a manuscript in any library remains to remind us of the learned and venerable men and women who did so much for medicine in those dark ages. A few years back I visited Salerno myself, and I found not even a decent hotel in which to remain a night or two. I rested at the best hostelry I could find, and after dinner proposed to the friend who accompanied me, that on the following day we should visit Pæstum and see its noble ruined temples. As we chatted and turned over the pages of the visitors’ book, we came across a long and doleful account of an Englishman who some few years previously had visited Pæstum from Salerno, and was captured by brigands; he was detained their prisoner for many weeks, and only at last liberated, after threats of mutilation, by the payment of a heavy ransom. We did not go to Pæstum; we left Salerno early the following morning and went to Amalfi. The hotel was gloomy and crumbling into decay, the rooms were all empty, the landlord was suggestive of the host in some of the old stories of our boyish days. Thus has Salerno fallen. Most travellers now make La Cava their headquarters, and do not stay at Salerno at all.