The education of Christian priests and infidel practitioners embraced really very little, and consisted, for the most part, of knowledge of a few symptoms and possession of a few receipts; books were excessively rare and expensive, capable teachers lacking, and a good medical education out of the question. There was no law nor public regulation which concerned the practice of medicine, and any who desired could enter upon it; while besides the priests and the Jews—which latter stood at the top of the scale—there was a multitude of charlatans of the lowest order, such as barbers, keepers of baths, and even a few women. The morality of this vulgar herd was on a level with its knowledge. I have said the practice of medicine was not regulated by law, yet Theodoric, King of the Visigoths, enacted a statute that no physician should bleed a woman of noble birth without the assistance of a relative or domestic; that if a physician in treating a patient or dressing a wound happened to harm a gentleman he should pay a forfeit of one hundred sous, and if the patient died from the operation he should be handed over to the relatives of the deceased, who could do with him whatever they pleased; while if he crippled or caused the death of a serf, he was to be held accountable only for the loss, and compelled to supply another. This remained in force from the sixth to the twelfth century, and was made to apply chiefly to the practice of surgery, which had been abandoned to individuals of the lowest condition. The practice of internal medicine was, for the principal part, the privilege of the clergy, and it is not likely the secular power ever expected that one protected with the title of priest should be handed over to the relatives of the dead. It furthermore appears that the practice of medicine as divorced from surgery led to such irregularities in the manners and conduct of the clergy that from the twelfth century popes and councils of the church repeatedly forbade the medical art to those in holy orders or under vows; but that this prohibition was often violated is shown by the frequent reiteration of inhibitory laws. During the twelfth century the secular authority was also affected by abuses. Roger, founder of the kingdom of Sicily, one of the first Christian princes of the Middle Ages, gave special attention thereto, and in 1140 proclaimed that every one who wished to practice medicine must present himself before a magistrate and obtain authorization, under pain of imprisonment and confiscation of goods. Other sovereigns followed this example, and regulating ordinances were gradually established, which ultimately led to the institution of medical faculties and university degrees.
During the Middle Ages, in the Empire of the West, arose the School of Salernum, which became so celebrated that, like that of Alexandria, it deserves special mention. The modern city of Salerno is situated on the Neapolitan Gulf, about thirty miles southeast of the city of Naples, with a population of but a few thousand souls. The ancient city stood upon a height in the rear of the present town, where the ruins of its mediaeval citadel are still to be seen. It first appeared in history 194 B.C., when a Roman colony was founded, was a municipal town of importance, and appears even at this early day to have been a health resort, since Horace informs us he had been advised to substitute its cool baths for the warm ones of Baiæ. During the stormy centuries following the downfall of the Western Empire, Salerno successively submitted to the sway of the Goths, Lombards, Franks, Saracens, and Greeks, as the vicissitudes of Avar compelled. Under the Lombards it became the residence of the Duke of Benevcntum, and, in 1075, when taken by Robert Guiscard of Normandy, it fell to the crown of Naples, in consequence of which in the fourteenth century, the heir apparent of this kingdom took the title of Prince of Salernum.
During the Middle Ages here flourished a medical school, important not alone because of its celebrity at the time, but for its effect upon the medical history of the future. Its origin is obscure, though it has been ascribed to Charlemagne in 802; again, its founding has been held to be the work of fugitives from Alexandria when that city was captured by the Saracens, 640 A.D.; some attribute it to the Benedictine order of monks, others to Saracens, etc. The foundation by Alexandrian fugitives is probably conjectural, yet it must be admitted there is some evidence of knowledge of Arabian medicine in Salernum as early as this. Be the origin what it may, it is certain that the Benedictine monks exercised a very important influence upon this school, and there is considerable reason to think that it was really originated by them. Their monastery of Monte Casino was located about fifty miles the other side of Naples, occupying the site of an ancient temple of Apollo; the rules of the order enjoined the care of the sick and treatment by prayer, and St. Benedict himself was credited with performing miraculous cures. The rules which forbade public instruction were gradually discarded, for in the ninth century Abbot Bertharius wrote two books on the art of healing, and by the tenth century Monte Casino had acquired great reputation as a medical school, and was sought by medically-inclined monks from all quarters. A little later (1022) King Henry II, of Bavaria, Emperor of Germany, is said to have been cut for stone by St. Benedict himself, who appeared in ghostly form and operated with such skill that on awaking the royal patient found the calculus in his hand, and only the cicatrix of the wound through which it had been removed. Of course, the grateful emperor could do no less than richly endow the monastery, and bestow upon it additional privileges.
Desiderius, the Benedictine abbot from 1058 to 1086, and in the eleventh century promoted to the papal chair under the title of Victor III, was distinguished for his attainments in medicine and in music, and founded a new hospital in connection with the monastery; he also composed four books detailing the miraculous cures wrought by his patron saint. It was really within this monastery that Constantine the African, one of the most learned men and the most famous Christian physician of his time, compiled his numerous medical treatises.
About Constantine there is much of romance. He was born in Carthage in 1018 and died in 1085. He visited all the prominent schools of his day in Egypt, Bagdad, Babylon, and even India, and for thirty-nine years pursued the various branches of knowledge away from home. Returning to Carthage, misunderstood and feared, he was accused of practicing sorcery and compelled to fly to save his life. Disguised as a beggar he escaped to Salernum, which had been recently captured by Robert Guiscard, and on the recommendation of some royal visitor, who had known him at another court, he was made private secretary to Guiscard. His new duties soon became irkscme, however, and he retired to a cloister to devote himself to literary labors. These, for the most part, were translations of Greek and Arabic writings, often made verbatim and without credit. Whatever may be said about this lack of honesty, and the barbaric nature of his Latin, credit must be given him for reviving the study of Hippocrates and Galen in France; and he is generally credited with being the first to introduce into Europe knowledge of Arabian medicine.
From Monte Casino the Benedictines at an early day spread to Salernum, where, by the middle of the tenth century, three monasteries were established, in all of which were kept holy relics. It now appears that, although there may have been some previous institution of learning at this point, and possibly even medical teachers, the real organization of a regular school of medicine was due to the Benedictines. In the annals of Naples of the middle of the ninth century the names of Salernian physicians are mentioned; and it is known that toward the close of the tenth century Archbishop Verdun visited Salernum for relief from vesical calculus, and there died.
The earliest medical writings of this school which have been preserved are found in the Compendium Salernitanum, discovered in manuscript form in 1837; and among the more prominent authors quoted are: Petronius, who wrote about 1035; Gariopontus, who wrote about 1040; Bartholomæus, Ferrarius, and Affiacius,—the latter a disciple of Constantius Africanus.
The preaching of Peter the Hermit, which marked the close of the eleventh century, was followed by an outburst of crusading enthusiasm that quickly converted Europe into a vast camp, and Salernum, being situated upon the highroad to the East, was benefited in no small degree and its reputation as a medical school materially enhanced; likewise its teachers gained in experience as regards military surgery. In this way it became a favorite resort for crusaders when disabled, wounded, or diseased. Robert of Normandy, son of the conqueror, returning from the Holy Land, remained here for some time with a poisoned wound in the arm, received in 1097 at the siege of Jerusalem, and it was decided it could be healed only by sucking out the poison, a process deemed dangerous to the operator. History declares that Robert's wife, daughter of Goeffrey, Earl of Conversana, being denied permission, took advantage of her husband's unconsciousness during sleep to withdraw the poison, when the wound speedily healed. At the time of the departure of Robert, hastened by the death of his brother William, John of Milan, the then chief of the medical school, presented him with the famous Regimen Sanitatis Salerni, said to have been composed largely for Robert's benefit. This was a Latin poem that enjoyed most unexampled popularity for many generations, and was the vade mecum of well-educated physicians for centuries. It is said to have passed through two hundred and forty different editions, and that more than one hundred manuscript copies are to-day to be found in various European libraries. The latest English version was published by Professor Ordronaux in 1871. A sample is here submitted:—
"Salerno's school in conclave high unites
To counsel England's king, and thus indites: