The Medical School At Salerno

The Medical School at Salerno, probably organized early in the tenth

century, often spoken of as the darkest of the centuries, and reaching

its highest point of influence at the end of the twelfth century, is of

great interest in modern times for a number of reasons. First it brought

about in the course of its development an organization of medical

education, and an establishment of standards that were to be maintained

whenever and wherever there was a true professional spirit down to our

own time. They insisted on a preliminary education of three years of

college work, on at least four years of medical training, on special

study for specialist's work, as in surgery, and on practical training

with a physician or in a hospital before the student was allowed to

practise for himself. At Salerno, too, the department of women's

diseases was given over to women professors, and we have the text-books

of some of these women medical teachers. The license to practise given

to women, however, seems to have been general and did not confine them

merely to the care of women and children. We have records of a number of

these licenses issued to women in the neighborhood of Salerno. This

subject of feminine medical education at Salerno, because of its special

interest in our time, will have a chapter by itself.



These are the special features of medical education in our own time

that we are rather prone to think of as originating with ourselves and

as being indices of that evolution of humanity and progress in mankind

which are culminating in our era. It is rather interesting, then, to

study just how these developments came about and what the genesis of

this great school was. The books of its professors were widely read, not

only in their own generation but for centuries afterwards. With the

invention of printing at the time of the Renaissance most of them were

printed and exerted profound influence over the revival of medicine

which took place at that time. Salerno became the first of the

universities in the modern sense of the word. Here there gathered round

the medical school, first a preparatory department representing modern

college work, and then departments of theology and law, though this

latter department particularly was never quite successful. The fact that

the first university, that of Salerno, should have been organized round

a medical school, the second, that of Bologna, around a law school, and

the third, that of Paris, around a school of theology and philosophy,

would seem to represent the ordinary natural process of development in

human interests. First man is interested in himself and in his health,

then in his property, and finally in his relations to his fellow-man and

to God.



Though much work has been done on the subject in recent years, it is not

easy to trace the origin of the medical school at Salerno. The

difficulty is emphasized by the fact that even the earliest chroniclers

whose accounts we have were not sure as to its origin, and even had

some doubt about the age of the school. Alphanus, usually designated

Alphanus I because there are several of the name, who is one of the

earliest professors whose name and fame have come down to us, gives us

the only definite detail as to the age of the school. He was a

Benedictine monk, distinguished as a literary man, known both as poet

and physician, who was afterwards raised to the Bishopric of Salerno. As

a bishop he was one of the beneficent patrons, to whom the school owed

much. He lived in the tenth century, and states that medicine flourished

in the town before the time of Guimarus II, who reigned in the ninth

century. In the ancient chronicle of Salerno, re-discovered by De Renzi

and published in his Collectio Salernitana, it is definitely recorded

that the medical school was founded by four doctors,--a Jewish Rabbi

Elinus, a Greek Pontus, a Saracen Adala, an Arab, and a native of

Salerno, each of whom lectured in his native language. There are many

elements in this tradition, however, that would seem to indicate its

mythical origin and that it was probably invented after the event to

account for the presence of teachers in all these languages and the

coming of students from all over the world. The names, for instance, are

apparently corruptions of real names, as can be readily recognized.

Elinus, the Jew, is probably Elias or Eliseus, Adala is a corruption of

Abdallah, and Pontus, as pointed out by Puschmann in his History of

Medical Education, should probably be Gario-Pontus.



While we do not know exactly when the medical school at Salerno was

founded, we know that a hospital was established there as early as 820.

It was founded by the Archdeacon Adelmus, and was placed under the

control of the Benedictines after it was realized that a religious

order, by its organization, was best fitted for carrying on such

charitable work continuously. Other infirmaries and charitable

institutions, mainly under control of the religious, sprang up in

Salerno. It was the presence of these hospitals in a salubrious climate

that seems first to have attracted the attention of patients and then of

physicians from all over Europe and even adjacent Africa and Asia.

Puschmann says that it is uncertain whether clinical instruction was

imparted in these institutions or not, but the whole tenor of what we

know about the practical character of the teaching at Salerno and of the

fine development of professional medicine there, would seem to argue

that probably those who came to study medicine here were brought

directly in contact with patients.



As early as the ninth century Salerno was famous for its great

physicians. We know the names of at least two physicians, Joseph and

Joshua, who practised there about the middle of the ninth century.

Ragenifrid, a Lombard by his name, was private physician to Prince

Wyamar of Salerno in the year 900. The fact that he was from North Italy

indicates that already foreigners were being attracted, but more than

this that they were obtaining opportunities unhampered by any

Chauvinism. From early in the tenth century physicians from Salerno were

frequently brought to foreign courts to become the attending physicians

to rulers. Patients of the highest distinction from all over Europe

began to flock to Salerno, and we have the names of many of them. In

the tenth century Bishop Adalberon, when ailing, went there, though he

found no cure for his ills. Abbot Desiderius, however, the great

Benedictine scholar of the time, who afterwards became Pope Victor III,

regained his health at Salerno under the care of the great Constantine

Africanus, who was so much impressed by the gentle kindness and deep

learning and the example of the saintly life of his patient that not

long after he went to Monte Cassino to become a Benedictine under

Desiderius, who was abbot there. Duke Guiscard sent his son Bohemund to

Salerno for the cure of a wound received in battle, which had refused to

heal under the ordinary surgical treatment of the time. William the

Conqueror, early in the eleventh century and while still only the Duke

of Normandy, is said to have passed some time at Salerno for a similar

reason.



The most interesting feature of the medical life at Salerno at this time

is the relations between the clergy and the physicians. In the sketch of

the life of Constantine Africanus, which follows this chapter, there is

some account of the friendship between Abbot Desiderius of Monte Cassino

and Constantine Africanus, and the latter's withdrawal from his

professorship to become a Benedictine. One of the physicians of the

early tenth century who stood high in favor with Prince Gisulf was

raised to the Bishopric of Salerno. This was Alphanus, whom we have

already mentioned as a chronicler, a monk, a poet, a physician, and

finally the Bishop of Salerno.



The best proof of how thorough was the medical education at Salerno and

how much influence it exerted even over public opinion is to be found in

the regulation of the practice of medicine, which soon began, and the

insistence upon proper training before permission to practise medicine

was granted. The medical school at Salerno early came to be a recognized

institution in the kingdom of the Two Sicilies, representing a definite

standard of medical training. It is easy to understand that the

attraction which Salerno possessed for patients soon also brought to the

neighborhood a number of irregular physicians, travelling quacks, and

charlatans. Wealthy patients were coming from all over the world to be

treated at Salerno. Many of them doubtless were sufferers from incurable

diseases and nothing could be done for them. Often they would be quite

unable to return to their homes and would be surely unwilling to give up

all hope if anybody promised them anything of relief. There was a rich

field for the irregular, and of course, as always, he came. Salerno had

already shown what a good standard of medical education should be, and

it is not surprising, then, that the legal authorities in this part of

the country proceeded to the enforcement of legal regulations demanding

the attainment of this standard, in order that unfit and unworthy

physicians might not practise medicine to their own benefit but to the

detriment of the patients.



Accordingly, as early as the year 1140, King Ruggiero (Roger) of the Two

Sicilies promulgated the law: Whoever from this time forth desires to

practise medicine must present himself before our officials and judges,

and be subject to their decision. Anyone audacious enough to neglect

this shall be punished by imprisonment and confiscation of goods. This

decree has for its object the protection of the subjects of our kingdom

from the dangers arising from the ignorance of practitioners.



Just about a century later the Emperor Frederick II, the Hohenstaufen,

in the year 1240, extended this law, emphasized it, and brought it

particularly into connection with the great medical school of the Two

Sicilies, of which territory he was the ruler. This law has often been

proclaimed as due to his personality rather than to his times,--as

representing his very modern spirit and his progressive way of looking

at things. There is no doubt that certain personal elements for which he

should be given due credit are contained in the law. To understand it

properly, however, one must know the law of King Roger of the preceding

century; and then it is easy to appreciate that Frederick's regulation

is only such a development of the governmental attitude toward medical

practice as might have been expected during the century since Roger's

time. It has sometimes been suggested that this law made by the Emperor

Frederick, who was so constantly in bitter opposition to the Papacy, was

issued in despite of the Church authorities and represents a policy very

different from any which they would have encouraged. The early history

of Salerno, even briefly as we have given it, completely contradicts any

such idea. The history of medical regulation at the beginning of the

next century down at Montpellier moreover, where the civil authorities

being weak the legal ordering of the practice of medicine was

effectively taken up by the Church, and the authority for the issuance

of licenses to practise was in the hands of the bishops of the

neighborhood, shows clearly that it is not because of any knowledge of

the real medical history of the times that such remarks are made, but

from a set purpose to discredit the Church.



The Emperor Frederick's law deserves profound respect and consideration

because of the place that it holds in the legal regulation of the

practice of medicine. Anyone who thinks that evolution must have brought

us in seven centuries much farther in this matter than were the people

of the later Middle Ages should read this law attentively. Everyone who

is interested in medical education should have a copy of it near him,

because it will have a chastening effect in demonstrating not only how

little we have done in the modern time rather than how much, but above

all how much of decadence there was during many periods of the interval.

The law may be found in the original in The Popes and Science (Fordham

University Press, N.Y., 1908). Three years of preliminary university

education before the study of medicine might be taken up, four years of

medical studies proper before a degree was given, a year of practice

with a regularly licensed physician before a license to practise could

be obtained, a special course in anatomy if surgery were to be

practised; all this represents an ideal we are striving after at the

present time in medical education. Besides this, Frederick's law also

regulates medical fees, requires gratuitous attendance on the poor for

the privilege of practice accorded by the license, though the general

fees are of a thoroughly professional character and represent for each

visit of the physician about the amount of daily wage that the ordinary

laborer of that time earned. Curiously enough, this same ratio of

emolument has maintained itself. This law was also a pure drug law,

regulating the practice of pharmacy, and the price as well as the purity

of drugs, and the relations of physicians, druggists, and the royal drug

inspectors whose business it was to see that only proper drugs were

prepared and sold.



All this is so much more advanced than we could possibly have imagined,

only that the actual documents are in our possession, that most people

refuse to let themselves be persuaded in spite of the law that it could

have meant very much. Especially as regards medical education are they

dubious as to conditions at this time. To them it seems that it can make

very little difference how much time was required for medical study or

for studies preliminary to medicine, since there was so little to be

learned. The age was ignorant, men knew but little, and so very little

could be imparted no matter how much time was taken.



This is, I fear, a common impression, but an utterly false one. The

preliminary training that is the undergraduate work at the universities

consisted of the Seven Liberal Arts--the trivium and quadrivium, which

embraced logic, rhetoric, grammar, metaphysics, under which was included

not a little of physics, cosmology in which some biology was studied, as

well as psychology and mathematics, astronomy, and music. This was a

thoroughly rounded course in intellectual training. No wonder that

Professor Huxley said in his Inaugural Address as Rector of Aberdeen, I

doubt if the curriculum of any modern university shows so clear and

generous a comprehension of what is meant by culture as this old trivium

and quadrivium does. There is no doubt at all about the value of the

undergraduate training, nor of the scholarship of the men who were

turned out under the system, nor of their ability to concentrate their

minds on difficult subjects--a faculty that we strive to cultivate in

our time and do not always congratulate ourselves on securing to the

degree, at least, that we would like.



As to the medical teaching, AEgidius, often called Gilles of Corbeil, who

was a graduate of Salerno and afterward became the physician-in-ordinary

to Philip Augustus, King of France, thought that he could not say too

much for the training in medicine that was given at this first of the

medical schools. One thing is sure, the professors were eminently

serious, the work taken up was in many ways thoroughly scientific, and

some of the results of the medical investigations of that early day are

interesting even now. The descriptions of diseases that we have from the

Salernitan school are true to nature and are replete with many original

observations. Puschmann says: The accounts given of intermittent fever,

pneumonia, phthisis, psoriasis, lupus, which they called the malum

mortuum, of ulcers on the sexual organs, among which it is easy to

recognize chancre, and of the disturbances of the mental faculties,

especially deserve mention. They seem to have been quite expert in

their knowledge of phthisis. In the treatment of it they laid great

stress upon the giving up of a strenuous life, the living a rather easy

existence in the open air, and a suitable diet. When the commencement of

consumption was suspected, the first prescription was a good course of

strengthening nourishment for the patient. On the other hand, they

declared that the cases in which diarrhea supervened during consumption

soon proved fatal. In general, with regard to people who were liable to

respiratory diseases, they insisted upon life in an atmosphere of

equable temperature. Though the custom was almost unheard of in the

Salerno of that time, and indeed at the present time there is very

little heating during the winter in southern Italy, they insisted that

patients who were liable to pulmonary affections should have their rooms

heated.



On the other hand, they suggested the cooling of the air of the

sick-room, as we have noted in the chapter on Constantine Africanus, and

Afflacius recommended the employment of an apparatus from which water

trickled continuously in drops to the ground and then evaporated. Baths

and bleeding were employed according to definite indications and diet

was always a special feature. They had a number of drugs and simples,

and the employment of some of them is interesting. Iron was prescribed

for enlargement of the spleen. The internal use of sea sponge, in which

of course there is a noteworthy proportion of iodine, was recommended

for relief from the symptoms of goitre by reducing its size. Iodine has

been used so much ever since in this affection, even down to our own

day, that this employment of one of its compounds is rather striking.

Massage of the goitre was also recommended, and this mode of treatment

was commonly employed for a number of ailments.



Probably the best idea that can be obtained in brief space of the

achievements of the University of Salerno is to be found in Pagel's

appreciation of Salerno's place in the history of medicine in his

chapters on Medicine in the Middle Ages in Puschmann's Handbuch der

Geschichte der Medizin (Berlin, 1902). He said: If we take up now the

accomplishments of the school of Salerno in the different departments

there is one thing that is very remarkable. It is the rich independent

productivity with which Salerno advanced the banners of medical science

for hundreds of years almost as the only autochthonous centre of medical

influence in the whole West. One might almost say that it was like a

versprengten Keim--a displaced embryonic element--which, as it

unfolded, rescued from destruction the ruined remains of Greek and Roman

medicine. This productivity of Salerno, which may well be compared in

quality and quantity with that of the best periods of our science, and

in which no department of medicine was left without some advance, is one

of the striking phenomena of the history of medicine. While positive

progress was not made, there are many noteworthy original observations

to be chronicled. It must be acknowledged that pupils and scholars set

themselves faithfully to their tasks to further as far as their strength

allowed the science and art of healing. In the medical writers of the

older period of Salerno who had not yet been disturbed by Arabian

culture or scholasticism, we cannot but admire the clear, charmingly

smooth, light-flowing diction, the delicate and honest setting forth of

cases, the simplicity of their method of treatment, which was to a great

extent dietetic and expectant, and while we admire the carefulness and

yet the copiousness of their therapy, we cannot but envy them a certain

austerity in their pharmaceutic formulas and an avoidance of

medicamental polypragmasia. The work in internal medicine was especially

developed. The contributions to it from a theoretic and a literary

standpoint, as well as from practical applications, found ardent

devotees.



Less than this could scarcely have been expected from the medical school

which brought such an uplift of professional dignity and advance in the

standards of medical education that are to be noticed in connection with

Salerno. Registration, licensure, preliminary education, adequate

professional studies, clinical experience under expert guidance, even

special training for surgical work, all came in connection with this

great medical school. Such practical progress in medical education could

not have been made but by men who faced the problems of the practice of

medicine without self-deception and solved them as far as possible by

common-sense, natural, and rational methods.



It is usually said that at Salerno surgery occupied an inferior

position. It is true that we have less record of it in the earlier years

of Salerno than we would like to see. It was somewhat handicapped by the

absence of human dissection. This very important defect was not due to

any Church opposition to anatomy, as has often been said, but to the

objection that people have to seeing the bodies of their friends or

acquaintances used for anatomical purposes. In the comparatively small

towns of the Middle Ages there were few strangers, and therefore very

seldom were there unclaimed bodies. The difficulty was in the obtaining

of dissecting material. We had the same difficulty in this country until

about two generations ago, and the only way that bodies could be

obtained regularly was by resurrecting them, as it was called, from

graveyards. In the absence of human subjects, anatomy was taught at

Salerno upon the pig. The principal portion of the teaching in anatomy

consisted of the demonstration of the organs in the great cavities of

the body and their relations, with some investigations of their form and

the presumed functions of the corresponding organs in man. Copho's

well-known Anatomy of the Pig was a text-book written for the students

of Salerno. In spite of its limitations, it shows the beginnings of

rather searching original inquiry and even some observations in

pathological anatomy. It is simple and straightforward and does not

profess to be other than it is, though it must be set down as the first

reasonably complete contribution to comparative anatomy.



When their surgery came to be written down, however, it gave abundant

evidence of the thoroughness with which this department of medicine had

been cultivated by the Salernitan faculty. We have the text-book of

Roger, with the commentary of Rolando, and then the so-called commentary

of the Four Masters. These writings were probably made rather for the

medical school at Bologna than that of Salerno, though there is no

doubt that at least Roger and Rolando received their education at

Salerno and embodied in their writings the surgical traditions of that

school. While I have preferred, in order to have a connected story of

surgical development, to treat of their contributions to their specialty

under the head of the Great Surgeons of the Medieval Universities, it

seems well to point out here that they must be considered as

representing especially the surgical teaching of the older medical

school of Salerno. There are many interesting features of the old

teaching that they have embodied in their books. For instance, at

Salerno both sutures and ligatures were employed in order to prevent

bleeding. We are rather accustomed to think of such uses of thread, and

especially the ligature, as being much later inventions. The fact of the

matter is, however, that ligatures and sutures were reinvented over and

over again and then allowed to go out of use until someone who had no

idea of their dangers came to reinvent them once more.[8]



Much is often said about the place of Arabian surgery and medicine at

this time, and the influence that they had over the medical teaching and

thinking of the period. To trust many of the shorter histories of

medicine the Arabs must be given credit for more of the medical thought

of this time than any other medical writers or thinkers. It is

forgotten, however, apparently, that in the southern part of Italy,

where Salerno was situated, Greek influence never died out. This had

been a Greek colony in the olden time and continued to be known for many

centuries after the Christian era as Magna Graecia. Greek medicine, then,

had more influence here than anywhere else. As a matter of fact, the

beginnings of Salernitan teaching are all Greek and not at all Arabian.

This is as true in surgery as in medicine. I have quoted Gurlt in the

chapter on Great Surgeons of the Medieval Universities, insisting that

the Salernitan school owed nothing at all to Arabian surgery. Salernitan

medicine was, during the twelfth century, just as free from Arabian

influence. When Arabian medicine makes itself felt, as pointed out by

Pagel in his Geschichte der Heilkunde im Mittelalter,[9] far from

exerting a beneficial influence, it had a rather unfortunate effect. It

led especially to an oversophistication of medicine from the standpoint

of drug therapeutics. The Arabian physicians trusted nature very little.

In this they were like our forefathers of medicine one hundred years

ago, of whom Rush was the typical representative--so history repeats

itself.



Before the introduction of Arabian medicine the Salernitan school of

medicine was noted for its common-sense methods and its devotion to all

the natural modes of healing. It looked quite as much to the prevention

of disease as its treatment. Diet and air and water were always looked

upon as significant therapeutic aids. With the coming of Arabian

influence there began, says Pagel, as the literature of the times shows

very well, that rule of the apothecary in therapeutics which was an

unfortunate exaggeration. Now all the above-mentioned complicated

prescriptions came to be the order of the day. Apparently the more

complicated a prescription the better. Dietetics especially was

relegated to the background. Salerno, at the end of the twelfth century,

had already reached its highest point of advance in medicine and was

beginning to decline. Decadence was evident in so far as all the medical

works that we have from that time are either borrowings or imitations

from Arabian medicine with which eventually Salernitan medical

literature became confounded. Only a few independent authors are found

after this time. This is so very different from what is ordinarily

presumed to have been the case and openly proclaimed by many historians

of medicine because apparently they would prefer to attribute

scientific advance to the Arabs than to the Christian scholars of the

time, that it is worth while noting it particularly.



Salerno was particularly rich in its medical literary products. Very

often we have not the names of the writers. Apparently there is good

reason to think that a number of the professors consulted together in

writing a book, and when it was issued it was considered to be a

text-book of the Salernitan school of medicine rather than of any

particular professor. This represents a development of co-operation on

the part of colleagues in medical teaching that we are likely to think

of as reserved for much later times.



The most important medical writing that comes to us from Salerno, in the

sense at least of the work that has had most effect on succeeding

generations, has been most frequently transcribed, most often translated

and committed to memory by many generations of physicians, is the

celebrated Salernitan medical poem on hygiene. The title of the original

Latin was Regimen Sanitatis Salernitanum. It was probably written

about the beginning of the twelfth century. A century or so later it

came to be the custom to call medical books after flowers, and so we had

the Lilium Medicinae and the Flos Medicinae down at Montpellier, and

this became the Flos Medicinae of Salerno. Pagel calls it the

quintessence of Salernitan therapeutics.



For many centuries portions at least of this Latin medical poem were as

common in the mouths of physicians all over Europe as the aphorisms of

Hippocrates or the sayings of Galen. Probably this enables us to

understand the great reputation that the Salernitan school enjoyed and

the influence that it wielded better than anything else. The poem is

divided into ten principal parts, containing altogether about 3,500

lines. The first part on hygiene has 855 lines in eight chapters. The

second part on materia medica, though containing only four chapters,

has also about 800 lines. Anatomy and physiology are crowded into about

200 lines, etiology has something over 200, semiotics has about 250,

pathology has but thirty lines more or less, and therapeutics about 400;

nosology has about 600 more, and finally there is something about the

physician himself, and an epilogue. As Latin verses go, when written for

such purposes, these are not so bad, though some of them would grate on

a literary ear. The whole work makes a rather interesting compendium of

medicine, with therapeutic indications and contra-indications, and

whatever the physician of the medieval period needed to have ready to

memory. Some of its prescriptions, both in the sense of formulae and of

directions to the patient, have quite a modern air.



One very interesting contribution to medical literature that comes to us

from Salerno bears the title, The Coming of a Physician to His Patient,

or An Instruction for the Physician Himself. We have had a number of

such works published in recent years, but it is a little surprising to

have the subject taken up thus early in the history of modern

professional life. It is an extremely valuable document, as

demonstrating how practical was the teaching at Salerno. The work is

usually ascribed to Archimattheas, and it certainly gives a vivid

picture of the medical customs of the time. The instruction for the

immediate coming of the physician to his patient runs as follows: When

the doctor enters the dwelling of his patient, he should not appear

haughty, nor covetous, but should greet with kindly, modest demeanor

those who are present, and then seating himself near the sick man accept

the drink which is offered him (sic) and praise in a few words the

beauty of the neighborhood, the situation of the house, and the

well-known generosity of the family,--if it should seem to him suitable

to do so. The patient should be put at his ease before the examination

begins and the pulse should be felt deliberately and carefully. The

fingers should be kept on the pulse at least until the hundredth beat in

order to judge its kind and character; the friends standing round will

be all the more impressed because of the delay and the physician's words

will be received with just that much more attention.



The old physician evidently realized very well how much influence on the

patient's mind meant for the course of the disease. For instance, he

recommends that the patient should be asked to confess and receive the

sacraments of the Church before the doctor sees him, for if mention is

afterwards made of this the patient may believe that it is because the

doctor thinks that there is no hope for him. For the purpose of

producing an effect upon the patient's mind, the old physician does not

hesitate even to suggest the taking advantage of every possible source

of information, so as to seem to know all about the case. On the way to

see the sick person he [the physician] should question the messenger

who has summoned him upon the circumstances and the conditions of the

illness of the patient; then, if not able to make any positive diagnosis

after examining the pulse and the urine, he will at least excite the

patient's astonishment by his accurate knowledge of the symptoms of the

disease and thus win his confidence.



At the end of these preliminary instructions there is a rather

diplomatic--to say the least--bit of advice that might perhaps to a

puritanic conscience seem more politic than truthful. Since the old

professor insists so much on not disturbing the patient's mind by a bad

prognosis or any hint of it, and since even some exaggeration of what he

might think to be the serious outlook of the case to friends would only

lead to greater care of the patient, there is probably much more

justification for his suggestion than might be thought at first glance.

He says, When the doctor quits the patient he should promise him that

he will get quite well again, but he should inform his friends that he

is very ill; in this way, if a cure is affected, the fame of the doctor

will be so much the greater, but if the patient dies people will say

that the doctor had foreseen the fatal issue.



The story of the medical school of Salerno, even thus briefly and

fragmentarily told, illustrates very well how old is the new in

education,--even in medical education. There is scarcely a phase of

modern interest in medical education that may not be traced very clearly

at Salerno though the school began its career a thousand years ago, and

ceased to attract much attention over six hundred years ago. We owe

most of our knowledge of the details of its organization and teaching to

De Renzi. Without the devotion of so ardent a scholar it would have been

almost impossible for us to have attained so complete a picture of

Salernitan activities. As it is, as a consequence of his work we are

able to see this first of modern medical schools developing very much as

do our most modern medical schools. There has been an accumulation of

medical information in the thousand years, but the ways and modes of

facing problems and many of the solutions of them do not differ from

what they were in the distant past. The more we know about any

particular period, the more is this brought home to us. It is for this

that study of particular periods and institutions of the olden time, as

of Salerno, grows increasingly interesting, because each new detail

helps to fill in sympathetically the new-old picture of human activity

as it may be seen at all times.