In Asia Minor, where Greek influence persisted as it did not in Italy, we have a series of distinguished contributors to medicine, or rather, medical literature—that is, men whose books represent a valuable compilation and digestion of the important medical writings from before their time, often enriched by their own experience. The first of these was Aëtios Amidenus—that is, Aëtios of Amida—born in the town of that name in Mesopotamia on the Upper Tigris (now Diarbekir), who flourished in the sixth century. Aëtios, or in the Latin form Aëtius, wrote a textbook that has often been republished in the modern time, and that shows very clearly how well the physicians of this period faced their medical and surgical problems, how thoroughly equipped they were by faithful study of the old Greek writers, and how successfully they coped with the difficulties of the cases presented to them. He is eminently conservative, a careful observer, who uses all the means at his command and who well deserves the interest that has been manifested in him at many periods during the almost millennium and a half elapsed since his death.
After Aëtius came Alexander of Tralles, from another of these towns of Asia Minor that we would consider insignificant, sometimes termed Trallianus for this reason. He must be reputed one of the great independent thinkers in medicine whose writings have deservedly attracted attention not only in his own time, but long afterwards in the Renaissance period, and with whose works everyone who cares to know anything about the development of medical history must be familiar. One detail of his life has always seemed to me to correct a whole series of misapprehensions with regard to the earlier Middle Ages. Alexander was one of five brothers, all of whose names have come down to us through nearly 1,500 years because of what they accomplished at the great Capital of the East. The eldest of them was Anthemios, the architect of the great Church of Santa Sophia. A second brother was Methrodoros, a distinguished grammarian and teacher at Constantinople. A third brother was a prominent jurist in the Imperial Courts of the capital; while a fourth brother, Dioscoros, was, like Alexander, a physician of repute, but remained in his birthplace Tralles, and acquired a substantial practice there.
There is sometimes the feeling that at this time in the world’s history, the end of the sixth and the beginning of the seventh century, men had but little initiative, and above all very little power of achievement in the intellectual order. Anyone who knows Santa Sophia in Constantinople, however, will recognize at once that the architect who conceived and superintended the construction of that great edifice was a genius of a high order, not lacking in initiative, but on the contrary possessed of a wonderful power of original accomplishment. No greater constructive work, considering all the circumstances, has perhaps ever been successfully planned and executed. It would scarcely be expected that the brother of the man who conceived and finished Santa Sophia would, if he set out to write a textbook of medicine, make an egregious failure of it. Surely his work would not be all unworthy of his brother’s reputation, and the family genius should lift him up to important accomplishment. This is literally what we find true with regard to Alexander. After years of travel which led him into Italy, Gaul, Spain, and Africa, he settled down at Rome, and practised medicine successfully until a very old age, and probably lectured there, for some of his books are in the form of lectures.
Fortunately for us, he committed his knowledge and his experience to writing, which has come down to us.
A third of these greater writers on medicine in the early Middle Ages was Paul of Ægina—Æginetus as he is sometimes known. There has been some question as to his date in history, but as he quotes Alexander of Tralles there seems to be no doubt now that his career must be placed in the first half of the seventh century. We shall see more of him, as also of his great contemporaries and predecessors of the early Middle Ages, Aëtios and Alexander of Tralles, in a subsequent chapter. Besides these men who were known for their writings, a series of less known Christian physicians were praised by their contemporaries for their knowledge of medicine. Among them are particularly to be noted certain members of an Arabian family with the title Bachtischua, a name which is derived from the Arabic words Bocht Jesu—that is, servant of Jesus—who, having studied among the Greek Christians in the cities of Asia Minor, were called to the Court of Haroun al-Raschid and introduced Greek medicine to the Mohammedans. I have pointed out in my volume “Old-Time Makers of Medicine”[1] that “it was their teaching which aroused Moslem scholars from the apathy that characterized the attitude of the Arabian people towards science at the beginning of Mohammedanism.”
After this preliminary period of early medieval medical development, the next important phase of medicine and surgery in the Middle Ages developed in the southern part of Italy at Salerno. Here came the real awakening from that inattention to intellectual interests which characterized Italy after the invasion of the northern barbarians. The reason for the early Renaissance in this neighbourhood is not far to seek. In the older times Sicily had been a Greek colony, and the southern portion of Italy had been settled by Greeks and came to be known as Magna Græcia. The Greek language continued to be spoken in many parts even during the earlier medieval centuries, and Greek never became the utterly unknown tongue it was in Northern Italy. With the turning of attention to education in the later Middle Ages, the Southern Italians were brought almost at once in contact with Greek sources, and the earlier Renaissance began. With this in mind, it is comparatively easy to understand the efflorescence of culture in Southern Italy, and the development of the important University of Salerno and its great accomplishment, particularly in scientific matters, though all this came almost entirely as a consequence of the opportunity for Greek influence to have its effect there.
It is sometimes said that Arabian influence meant much for the development of Salerno, and that it was because the southern part of the Italian peninsula was necessarily rather closely in touch with Arabian culture that an early awakening took place down there. The Mohammedans occupied so many of the islands of the Mediterranean, as well as Spain, that their influence was felt deeply all along its shore, and hence the first university of Europe in modern times came into existence in this part of the world. Montpellier is sometimes, though not so often, said to have had the same factor in its early development. Undoubtedly there was some Arabian influence in the foundation of Salerno. The oldest traditions of the University show this rather clearly. This Arabian influence, however, has been greatly exaggerated by some modern historical writers. Led by the thought that Christianity was opposed to culture, and above all to science, they were quite willing to suggest any other influences than Christian as the source of so important a movement in the history of human progress as Salerno proved to be. The main influence at Salerno, however, was Greek, and the proof of this is, as insisted by Gurlt in his “History of Surgery,” that the great surgeons of Salerno do not refer to Arabian sources, but to Greek authors, and their books do not show traces of Arabian influences, but on the contrary have many Græcisms in them.
Salerno represents an especially important chapter in the history of Medieval Medicine. As we shall see, the teachers at the great medical school there set themselves in strenuous opposition to the Arabian tendency to polypharmacy, by which the Oriental mind had seriously hurt medicine, and what is still more to the credit of these Salernitan teachers, they developed surgery far beyond anything that the Arabs had attempted. Indeed, surgery in the later centuries of Arabian influence had been distinctly neglected, but enjoyed a great revival at Salerno. Besides, the Salernitan physicians used all the natural methods of cure, air, water, exercise, and diet, very successfully. If any other proof were needed that Arabian influence was not prominent at Salerno, surely it would be found in the fact that women physicians enjoyed so many privileges there. This is so entirely opposed to Mohammedan ways as to be quite convincing as a demonstration of the absence of Arabian influence.
From Salerno, the tradition of medicine and surgery spread to Bologna early in the thirteenth century, and thence to the other universities of Italy and to France. Montpellier represented an independent focus of modern progress in medicine, partly due to close relationship with the Moors in Spain and the Greek influences they carried with them from Asia Minor, but not a little of it consequent upon the remnants of the older Greek culture, still not entirely dead even in the thirteenth century, because Marseilles, not far away, had been a Greek colony originally, and still retained living Greek influence, and wherever Greek got a chance to exercise its stimulant incentive modern scientific medicine began to develop.
France owed most of her development in medicine and surgery at the end of the Middle Ages to the stream of influence that flowed out of Italian universities. Such men as Lanfranc, who was an Italian born but exiled; Mondeville, who studied in Italy; and Guy de Chauliac, who has so freely acknowledged his obligation to Italian teachers, were the capital sources of medical and surgical teaching in France in the later Middle Ages.