Doctors should thus their patients’ food revise—
What is it? When the meal? And what its size?
How often? Where? lest, by some sad mistake,
Ill-sorted things should meet and trouble make.
They recommended the various simples, mallow, mint, sage, rue, the violet for headache and catarrh, the nettle, mustard, hyssop, elecampane, pennyroyal, cresses, celandine, saffron, leeks—a sovereign remedy for sterility—pepper, fennel, vervaine, henbane, and others. There were certain special affections, as hoarseness, catarrh, headaches, fistula, for which specific directions for cure were given. Here for instance are the directions to be given a patient suffering from rheum or catarrh. The verses conveyed interesting information with nice long names for the various affections, as well as the directions for its management.
Fast well and watch. Eat hot your daily fare,
Work some, and breathe a warm and humid air;
Of drink be spare; your breath at time suspend;
These things observe if you your cold would end.
A cold whose ill-effects extend as far
As in the chest, is known as a catarrh;
Bronchitis, if into the throat it flows;
Coryza, if it reach alone the nose.
The Regimen conveyed a deal of information in compact form. It gives the number of bones in the body as 219 with 32 teeth, and the number of veins as 365, this number being chosen doubtless because of some supposed relation to the number of days in the year. It contains also a good brief account of the four humours in the human body—black bile, blood, phlegm, and yellow bile; and of the four temperaments—the sanguine, the bilious, the phlegmatic, and the melancholy. These four temperaments were discussed at considerable length by all the psychologists and most of the writers on religious life for centuries afterwards, largely on the basis of the information conveyed by the Salernitan handbook. There are descriptions of the symptoms of plethora or excess of blood, of excess of bile, of excess of phlegm, and excess of black bile. The little volume finally contains discussions as to bleeding, its indications, contraindications, as in youth—“Ere seventeen years we scarce need drawing blood”—and in old age; and then of the mode of practising it, and the place whence the blood should be drawn to relieve different symptoms.[5]
Salerno impressed itself much more deeply on surgery than on medicine, for the magnificent development of medieval surgery, the knowledge of which has proved so surprising in our day, began down at Salerno. Some of the details of this phase of Salernitan accomplishment are given in the chapter on Medieval Surgeons of Italy. Roger and Roland and the Four Masters were great original founders in a phase of medical science that proved extremely important for the next three or four centuries. Undoubtedly the presence of a hospital at Salerno, where there were gathered a number of the chronic cases from all over Europe, most of them of the better-to-do classes looking for ease from their ills, gave the incentive to this development. When the natural means of cure, tried for a considerable time, failed, recourse was had to surgery for relief, and often with excellent results. This chapter on Salerno’s history shows how thoroughgoing was the effort of the members of the faculty of the medical school to develop every possible means of aid for their patients, even when that required pioneer work.
Pagel’s appreciation of Salerno’s place in the history of medicine, in his chapter on Medicine in the Middle Ages in Puschmann’s “Handbuch Der Geschichte der Medicin,” Berlin, 1902, gives in very brief space a summary of what was accomplished at Salerno that emphasizes what has been said here, and his authority will confirm those who might possibly continue to doubt of any institution of the Middle Ages having achieved so much. He said:
“If we take up now the accomplishments of the School of Salerno in the different departments, there is one thing that is very remarkable. It is the rich, independent productivity with which Salerno advanced the banners of medical science for hundreds of years, almost as the only autochthonous centre of medical influence in the whole West. One might almost say that it was like a versprengten Keim—a displaced embryonic element—which, as it unfolded, rescued from destruction the ruined remains of Greek and Roman medicine. This productivity of Salerno, which may well be compared in quality and quantity with that of the best periods of our science, and in which no department of medicine was left without some advance, is one of the striking phenomena of the history of medicine. While positive progress was not made, there are many noteworthy original observations to be chronicled. It must be acknowledged that pupils and scholars set themselves faithfully to their tasks to further, as far as their strength allowed, the science and art of healing. In the medical writers of the older period of Salerno, who had not yet been disturbed by Arabian culture or scholasticism, we cannot but admire the clear, charmingly smooth, easy-flowing diction, the delicate and honest setting forth of cases, the simplicity of their method of treatment, which was to a great extent dietetic and expectant; and while we admire the carefulness and yet the copiousness of their therapy, we cannot but envy them a certain austerity in their pharmaceutic formulas, and an avoidance of medicamental polypragmasia. The work in internal medicine was especially developed. The contributions to it from a theoretic and literary standpoint, as well as from practical applications, came from ardent devotees.”
One very interesting contribution to medical literature that comes to us from Salerno bears the title “The Coming of a Physician to His Patient, or an Instruction for the Physician Himself.” It illustrates very well the practical nature of the teaching of Salerno, and gives a rather vivid picture of the medical customs of the time. The instruction as to the conduct of the physician when he first comes into the house and is brought to the patient runs as follows:
“When the doctor enters the dwelling of his patient, he should not appear haughty, nor covetous, but should greet with kindly, modest demeanour those who are present, and then seating himself near the sick man accept the drink which is offered him [sic], and praise in a few words the beauty of the neighbourhood, the situation of the house, and the well-known generosity of the family—if it should seem to him suitable to do so. The patient should be put at his ease before the examination begins, and the pulse should be felt deliberately and carefully. The fingers should be kept on the pulse at least until the hundredth beat in order to judge of its kind and character; the friends standing round will be all the more impressed because of the delay, and the physician’s words will be received with just that much more attention.”
The rest of the advice smacks rather more of sophistication than we care to think of in a professional man, but its display of a profound knowledge of human nature makes it interesting.