It mentions a certain "aqua mirabilis" composed largely of brandy, which spirit is said to have first been employed medicinally by Thaddeus of Florence, who died in 1295; there is also an account of a patient who wore spectacles! The diseases of women and children are also largely dealt with. The work is undoubtedly an anonymous production of the eleventh century, disfigured by additions of a later day, and ascribed to Trotula, perhaps, because of the celebrity that attached to her; at all events, it is the earliest work ascribed to a female physician, and thus possesses special claims to interest.
Later we read of Sichelguada, wife of Robert Guiscard and a graduate of Salernum, who endeavored to poison her step-son, Bohemond, in order to secure the succession of her own child. This infamous plot was furthered by some of the Salernian physicians, and thwarted only by the prompt action of Guiscard, who swore he would slay his wife with his own sword should the malady of Bohemond prove fatal.
Certain other female physicians of this period are mentioned, notably Abella, who, in spite of the modesty that is supposed to hedge about her sex, produced in Latin hexameter a work entitled De Natura Seminis Hominis. Mercuriolus, in the fifteenth century, produced treatises on the cure of wounds, pestilent fevers, and on the nails. The most celebrated of all, however, appears to have been Calenda, who lived during the reign of that notorious profligate, John II, of Naples (1414-1435), and who was particularly distinguished for her personal attractions. She graduated with great honor from the school at Salernum, and soon after, in 1423, married a nobleman of the court, which perhaps accounts for the fact that she never exercised the privilege of authorship. A little later, Marguerite, of Sicily or Naples, also a Salernian graduate, acquired an extended professional reputation, and was licensed to-practice by Ladislaus, King of Poland.
Daremberg informs us that there were numerous female physicians at Salernum, much sought after because of their talents, and, moreover, highly esteemed by the professors of the school, who freely quoted the writings of their fair pupils and contemporaries; further, that they employed ointments in paralyses; fumigations, vapors, and antimony for coughs; and lotions of aloe and rose-water for swellings of the face; they combined scientific knowledge with facetious playfulness in a manner peculiar to the sex, in that they tendered unsuspecting beaux bouquets of roses doctored with powdered euphorbium, and hugely enjoyed the forced sternutations of their victims.
It will thus be seen what a wide-spread and long-continued influence the school of Salernum exerted. At first physics and philosophy were the principal branches taught, but later the other sciences were cultivated. The Emperor Frederick II united the different schools of the city into a university,—a term, however, that, as then applied, appears to have corresponded to what in the nineteenth century is understood by corporation. The emperor likewise published several decrees which revised the duties and privileges of practitioners of medicine and surgery in his kingdom, and, in 1224, ordered that no person should practice within the two Sicilies until examined by the faculty of the university and licensed at the royal hands; further, practitioners were compelled to devote at least one year to the study of anatomy. The faculty at this time consisted of ten professors, whose salary probably depended upon the number of pupils. A candidate for graduation was required to present proof of majority, of legitimacy of birth, and of proper duration of preliminary study, and then was examined publicly in the Synopsis of Galen, the Aphorisms of Hippocrates, or the Canon of Avicenna. On passing he swore to conform to all the regulations hitherto observed in medicine, to give gratuitous treatment to the poor, and to expose all apothecaries detected in adulterating drugs. A book was then placed in his hands, a ring upon his finger, and a laurel crown upon his head, when he was "dismissed with a kiss." The degree conferred was that of "Magister"—the modern title of Doctor being at that period employed almost exclusively to designate a public teacher or professor.
But the watchfulness of King Frederick was not confined alone to the regulation of medical study within his kingdom. The number of professional visits, and the recompense therefor, were fixed by law. Every physician was compelled to visit his patients twice daily, and even once at night as well, if summoned, and for this attendance was permitted a daily fee equivalent to fourteen cents for patients within the city, while for calls without the city the largest legal charge was one dollar and thirteen cents, provided he paid his own expenses.
The earlier teachings and practice of Salernum were a curious mixture of methodism, dogmatism, and superstition. The latter may be better understood when it is recalled that the practice of medicine for an extended period was confined almost exclusively to ecclesiastics, who by their very education were prone to superstition and upheld the efficacy of charms and relics, and the active intervention of saints and martyrs as well as the myrmidons of evil; hence arose many of the conflicts and absurd notions peculiar to the period. The prevalence of the doctrine of medical methodism was due to the character of the writings most accessible to students of that day,—such as those of Ccelius Aurelianus and others; and it is curious that Celsus, the most elegant of medical authors, was never popular among medical monks. The Hellenic language having almost disappeared from Italy by the sixth century, the works of the Greek authors had become a sealed book to a vast majority, even of the better educated; hence the purer sources of medical knowledge were not available. Although the school of Salernum, at a later date, prided itself upon its devotion to the "Father of Medicine," the Hippocratic writings were not known at this period; and, when Constantine the African, by the translation of Arabian works, introduced a new element into the Salernian school, he ingrafted upon its medical teaching a form of doctrine which found a congenial atmosphere, in which it throve vigorously, while, a century later, the translations of Gerard of Cremona gave a stronger impulse to the growth of Hippocratic medicine than to Hippocratic doctrine.
From the Commentary of the Four Masters we learn that Salernian practitioners recognized the diagnostic importance of nausea, vomiting, and the flow of blood from the ears in injuries to the head; that they resorted to the trepan for depressed fractures and the relief of intracranial extravasation; that hernia cerebri was treated by pressure and caustics; that ligatures, both above and below the opening, were applied for the treatment of wounds of the carotid arteries and jugular veins. It was advised to decline patients suffering from wounds of the heart, lungs, diaphragm, stomach, or liver, in order to avoid the disgrace of losing them; and in penetrating wounds of the intestines and in those complicated with protrusion of the wounded gut instruction was given how to envelop them in the warm abdomen of a slaughtered animal until natural color and temperature were restored, and then to insert a cannula of alder-wood into the wounded intestine, which was to be neatly closed and stitched; finally, the protrusion was to be carefully washed with warm water and returned into the abdominal cavity, enlarging the opening for this purpose, if necessary. Also was advised the extraction of diseased teeth; and the operation of lithotomy was described with considerable care. Compound fractures were to be treated with splints. On the whole, this commentary of the alleged Four Masters is the most interesting and ancient Salernian work which has been preserved, and is well worthy the attention of even modern surgeons.
Such was the school of Salernum in its prime, during the twelfth and thirteenth centuries. My readers will not have failed to note how few names have been mentioned which are prominent in medical history, and how few improvements were made in medical art by those who have been mentioned. One naturally inquires, then, what was the source of the wide-spread fame of Salerno as a school, since it was distinguished neither by notable discovery in science nor by celebrated teachers, and the predominant element was doubtless one of obstinate conservatism and unswerving devotion to ancient doctrines. Founded during the dark period of the Middle Ages, at a time when ignorance, bigotry, and superstition prevailed, it preserved, amidst the gloom that had settled upon Europe, a few rays of that intellectual light which had shown so brightly in the golden ages of Roman history. These rays, made more conspicuous by the intellectual night which they barely illumined, were a beacon for men who were groping for more light. Thus the name of Salernum became synonymous with intellectual advancement in later ages. As the parent and model of our modern university system, Salernum yet deserves, in a measure, to enjoy the esteem of a numerous scholastic offspring. At a time when priests were particularly active in passing off rudimentary knowledge for the science of healing this school began to secure all information possible from the laity for the progressive development of medicine. It began, in other words, to hold aloof and then to break away from the fetters of a fanatical church. Its decline, too, was as rapid as its career had been brilliant. One very serious blow was struck when, in 1224, Frederick II founded the University of Naples and forbade Neapolitan subjects to seek instruction at any other university. The next year a revolt in the city provoked the closure of the schools of Bologna, which were, however, opened again two years later. Within a short time the universities of Naples, Montpellier, Padua, Paris, and Bologna all entered into a contest for pre-eminence with a rivalry which was not always generous. In 1224, it is said, the latter university had no less than ten thousand students. Happily, however, the period of the Renaissance proved to be one of emancipation from the fetters of ignorance and superstition, making an appeal for liberty which the conservatism of Salernum could not brook. Roger Bacon, in England; Lanfranc and Guy de Chauliac, in France; Mondino, at Bologna, and Savonarola, at Padua, found no rivals at Salernum to successfully contest their fame. Thus this ancient school fell behind the age, and in a short time sank into a mediocrity which was scarcely brightened by the reflection of a departed glory. In 1342 Robert I renewed the decree of Frederick II, which closed all the schools in his kingdom save those of Naples, but excepted Salernum solely because of its antiquity and the traditions of his predecessors. In 1413 King Ladislaus excepted the Salernian alumni and professors from all taxes, duties, and tribute. In the middle of the fourteenth century the poet Petrarch speaks of the school as a memory of the past; but its last appearance was in 1748, when a dispute at Paris relating to the rank of physicians and surgeons was referred to Salerno's university for arbitration and final decision. In 1811 a formal decree reduced this parent of all European universities to a mere gymnasium or preparatory school; and now one may wander through the streets of the modern town and among the ruins of its ancient predecessor and seek in vain to trace some reminder of those who were illustrious during some of the most terrible ages in the world's history. No echo of tradition, no stone of ancient edifice, no library preserving precious manuscripts, not even an edition of the old Salernian regimen, in the whole city; in fact, none now so poor as to do it reverence.