Characters and precepts of the Salerno Medical School

The Medical School was born and developed thanks to the presence of great figures connected with the Church, clergymen and monks, who practiced their profession for the material as well as spiritual welfare of the poor, the rich and the noble.
The monasteries, and especially the one dedicated to St. Benedict, were in fact also intended to house the sick, hostels for their infirmities. And great doctors were great clergymen, first among them Alfano, glory of Salerno, of the Medical School, of the Benedictine order, and of culture.
But most of all, explaining how important the care of bodies connected with the care of souls was is the idea behind the School’s teaching: that harmony and balance are really the source of health. Harmony between the four elements that make up Creation, namely air, water, earth and fire, which are the same elements that form the basis of our human body, and whose imbalances generate disease.
Balance between mind and food, to find in gladness and diet the best cures. Balance between disease and its cure, due especially to “officinal” herbs, which, cultivated in the gardens of convents, cure everything. And so it is written at the beginning of the Regimen Sanitatis Salernitanum, the text in Latin verse, which is the summary of the wisdom of the School, and which was to be sent by heart by every doctor. Thus reads the opening of the poem, dedicated to King Richard of England, who was healed in Salerno:
“If thou wilt guard thyself from evils, if thou wilt be healthy, cast off grave cares, do not indulge in wrath. Be sober in your drinking, moderate in your eating, do not be burdensome to yourself in walking after lunch, avoid afternoon sleep, do not retain urine, do not compress your anus with effort. If you observe these rules carefully, you will live healthy for a very long time. If you lack physicians, let these three principles be physicians to you: happy mind, rest, moderate diet.”
But what was taught in the Medical School in known times? How was the teaching organized?
First of all, it must be said that the School was secular, and this is its most important organizational aspect: a medieval university whose organization was entirely entrusted to secular orders, although, many, among the leading teachers, were churchmen, and clinics often corresponded with monasteries.
In the heart of Mediterranean Europe, in the centuries before the year 1,000, a cultural institution was already flourishing that answered only to itself and its purposes of teaching and caring for bodies. And, then, medicine was only one of the fields of teaching, for Salerno was also teaching and conferring degrees in philosophy, because no science is valid if it is not aided by a love of knowledge.
Over the centuries, its structure and teachings have changed, but, some elements have remained fixed: the relationship between self-care and removal from disease, care of the body and spirit, attention to diets, and the use of natural medicines made from plants grown in the city’s gardens.
In the beginning, the School was of practical medicine, meaning that it based its teaching on the precepts and observation of experienced physicians; the writings produced were, basically, of the compendium type, and, that is, pure and simple review of norms and principles. After the time of Alphanus, who translated from Greek, and Constantine, who presented texts from Arabic, often also Greek translations, there was a shift to commentarium, and, that is, to critical reworking of classical texts, enriched with glosses and commentaries. Thus, the method of teaching changed from pure observation of practice and the collection of cases and empirical methods to the study of the classics and the scholarly comparison of everyday practice and theory.
At this point, the need to structure the School organizationally as well asserted itself, and a corporate structure, already existing in ancient times, took shape: the Medical College. The existence of a professional body, protecting the interests of Salerno physicians, was felt and, at least in part, realized from the first centuries of the Medical School. But, it was not until the second half of the fifteenth century that the actual College was born, and, that is, an autonomous institution, provided with statutory regulations and consisting of a certain number of life members. The Collegium Doctorum was the exclusive holder of the right to confer degrees, and it retained this privilege until the end of its centuries-long history.
The Collegium consisted of ten ordinary members, of whom the most senior was the Prior, followed, then, by the Promoter, the Head of the Bank, the First Collegium, and so on. All Salerno physicians were Alumni and were entitled to access, over time, the College.
The prestige of the Prior was evidenced by the induction ceremony. The College invited the Promoter, the oldest member who was entitled to the right of succession, to fill the seat that had become vacant due to the Prior’s death. The Promoter sat in a separate chair from the Collegial bank, received the Prior’s cap, gloves and golden lace, and exchanged the kiss of peace with the Collegials.
The Prior not only conferred degrees, but also regulated, as well, justice among the Collegials, the Alumni and the Aromatarii ( i.e., apothecaries). His power also extended to the control of pharmacies and apothecaries and, therefore, the issuance of licenses and, finally, he controlled the spice and drug trade at the Fair. A great corporate power, which extended not only, therefore, to the practice of the profession, but also to trade and justice. And this lasted for centuries, until the School closed in 1811.
The aspect of the Medical School that is important to emphasize is that of its cultural openness, and its willingness to accept contributions that came from everywhere. Truly Greek and Arabic culture, philosophy and empirical science, study and application are the elements that made the Salerno Medical School great.
Among the thousand Salerno physicians there were many who came from afar, and the greatest among them was certainly Constantine the Africanus.
He came to Salerno from Carthage, where he was born, and, as Peter Deacon tells us, after long pilgrimages around the Mediterranean. First he went to Cairo to study grammar, dialectic, rhetoric, geometry, arithmetic, mathematics, astronomy, necromancy, music and physics of the Chaldeans, Arabs, Persians and Saracens; he would then continue his journey to India and Ethiopia. Back in Carthage his great erudition would make him disliked by his fellow citizens, who even considered killing him. Thus it was that Constantine fled to Salerno.
Other versions speak of a Constantine kidnapped by Salerno pirates and sold into slavery. Here he is said to have cured the prince of a serious illness and he was immediately freed.
If uncertain is his life before Salerno, then we can know with certainty that after living as a scholar and translator from Arabic in the city, he went to Monte Cassino to end his life as a monk.
Certainly he left us a number of important texts written in his own hand and a series of translations such that he was among the most distinguished physicians of the School, and certainly he was the one who most contributed to transforming it from a school of practical medicine to a full-fledged university.
We like to remember the figure of this great with a quote from him, which reveals what is, beyond doctrine, the true mission of a physician:
“The good physician, when he examines the sick, let him not direct his heart toward his wife, let him not dwell his eyes on his daughter and servant: for this blinds the heart of man. He should only be privy to the illness that has been confided to him: for sometimes the sick person reveals to the physician what he is ashamed to confide to family members instead. Shun lust, beware of the intoxicating delights of the world that disturb the mind and strengthen the vices of the body. Love perseverance in study in order to take care of the health of the body. Let him profit from lessons without becoming bored so that if he happens to miss books, memory may come to his aid. Let it not bother him to visit sick people of any kind so that he may be more and more proficient in practice. Let him be pious, humble, good-natured, amiable, and ready to ask for divine help.”
(From the Prologue to De Comminibus medico cognitu necessarii locis.)
What we find useful to tell about the Salerno Medical School is its practical and empirical spirit.
As in business, so in the sciences of doing, and thus in medicine, skills of observation, practice, and experience count. And in Salerno these methods were particularly alive and transmitted. Important is reading and study, important is the knowledge of Hippocrates and Galen, fundamental are the theories about the elements and the four temperaments.
But the good physician is one who observes, experiments, remembers and compares. And in the School this practical approach even reaches the study of anatomy, obviously not human anatomy, because it was forbidden to dissect bodies that are to be resurrected, but that of animals, to understand how they are formed and by comparison, how humans are made.
Practical and unprejudiced, so unprejudiced that even women were allowed to practice the medical art. There were many women physicians in Salerno, the most famous of all being Trotula, author of the Europe-wide famous “De mulierum passionibus in ante and post partum.”
Poisons were the specialty of Salerno’s physicians, and this is also evidenced by the story of Sichelgaita, the wife of Robert Guiscard, who was accused of trying to poison her stepson.
But women’s medical art in Salerno is also concerned with other cures, those of cosmetics: “The women of Salerno put the root of viticella in honey and then with this honey they anointed their faces: thus they cured the cracks and the face rejuvenated.” (Bernardo Provenzale). The body must be cared for, then, so that it remains healthy and, let’s face it, even beautiful. What’s the harm?