Mediaeval Medicine : Part 2

The Evolution of Modern Medicine
by William Osler

(Page 5 of 16)

About thirty miles southeast of Naples lay Salernum, which for centuries kept alight the lamp of the old learning, and became the centre of medical studies in the Middle Ages; well deserving its name of "Civitas Hippocratica." The date of foundation is uncertain, but Salernitan physicians are mentioned as early as the middle of the ninth century, and from this date until the rise of the universities it was not only a great medical school, but a popular resort for the sick and wounded. As the scholar says in Longfellow's "Golden Legend":

Then at every season of the year
There are crowds of guests and travellers here;
Pilgrims and mendicant friars and traders
From the Levant, with figs and wine,
And bands of wounded and sick Crusaders,
Coming back from Palestine.

There were medical and surgical clinics, foundling hospitals, Sisters of Charity, men and women professors - among the latter the famous Trotula - and apothecaries. Dissections were carried out, chiefly upon animals, and human subjects were occasionally used. In the eleventh and twelfth centuries, the school reached its height, and that remarkable genius, Frederick II, laid down regulations for a preliminary study extending over three years, and a course in medicine for five years, including surgery. Fee tables and strict regulations as to practice were made; and it is specifically stated that the masters were to teach in the schools, theoretically and practically, under the authority of Hippocrates and Galen. The literature from the school had a far-reaching influence. One book on the anatomy of the pig illustrates the popular subject for dissection at that time. The writings, which are numerous, have been collected by De Renzi.

The "Antidotarium" of Nicolaus Salernitanus, about 1100, became the popular pharmacopoeia of the Middle Ages, and many modern preparations may be traced to it.

The most prominent man of the school is Constantinus Africanus, a native of Carthage, who, after numerous journeys, reached Salernum about the middle of the eleventh century. He was familiar with the works both of the Greeks and of the Arabs, and it was largely through his translations that the works of Rhazes and Avicenna became known in the West.

One work above all others spread the fame of the school - the Regimen Sanitatis, or Flos Medicinae as it is sometimes called, a poem on popular medicine. It is dedicated to Robert of Normandy, who had been treated at Salernum, and the lines begin: "Anglorum regi scripsit schola tota Salerni . . . " It is a hand-book of diet and household medicine, with many shrewd and taking sayings which have passed into popular use, such as "Joy, temperance and repose Slam the door on the doctor's nose." A full account of the work and the various editions of it is given by Sir Alexander Croke, and the Finlayson lecture by Dr. Norman Moore gives an account of its introduction into the British Isles.

Byzantine Medicine

THE second great stream which carried Greek medicine to modern days runs through the Eastern Empire. Between the third century and the fall of Constantinople there was a continuous series of Byzantine physicians whose inspiration was largely derived from the old Greek sources. The most distinguished of these was Oribasius, a voluminous compiler, a native of Pergamon and so close a follower of his great townsman that he has been called "Galen's ape." He left many works, an edition of which was edited by Bussemaker and Daremberg. Many facts relating to the older writers are recorded in his writings. He was a contemporary, friend as well as the physician, of the Emperor Julian, for whom he prepared an encyclopaedia of the medical sciences.

Other important Byzantine writers were Aetius and Alexander of Tralles, both of whom were strongly under the influence of Galen and Hippocrates.

From Byzantium we have the earliest known complete medical manuscript, dating from the fifth century - a work of Dioscorides - one of the most beautiful in existence. It was prepared for Anicia Juliana, daughter of the Emperor of the East, and is now one of the great treasures of the Imperial Library at Vienna. From those early centuries till the fall of Constantinople there is very little of interest medically. A few names stand out prominently, but it is mainly a blank period in our records. Perhaps one man may be mentioned, as he had a great influence on later ages - Actuarius, who lived about 1300, and whose book on the urine laid the foundation of much of the popular uroscopy and water-casting that had such a vogue in the sixteenth and seventeenth centuries. His work on the subject passed through a dozen Latin editions.

The Byzantine stream of Greek medicine had dwindled to a very tiny rill when the fall of Constantinople dispersed to the West many Greek scholars and many precious manuscripts.

Arabian Medicine

THE third and by far the strongest branch of the Greek river reached the West after a remarkable and meandering course. The map before you shows the distribution of the Greco-Roman Christian world at the beginning of the seventh century. You will notice that Christianity had extended far eastwards, almost to China. Most of those eastern Christians were Nestorians and one of their important centers was Edessa, whose school of learning became so celebrated. Here in the fifth century was built one of the most celebrated hospitals of antiquity.

About the Author

William Osler (1849 - 1919) was a Canadian physician. He has been called one of the greatest icons of modern medicine and the Father of Modern Medicine (which is what he himself considered Avicenna to be).