Age of Transition (continued).—Arabic Period: A.D. 640-1400. Alkindus, 873. Mesue, 777-857. Rhazes, 850-932. Haly-Abas, 994. Avicenna, 980-1037. Albucassis, 1122. Avenzoar, 1113-1161. AverroËs, 11661198. Maimonides, 1135-1204. School of Salernum: Constantinus Afri-canus, 1018-1085. Roger of Salerno, 1210. Roland of Parma, 1250. The Four Masters, 1270 (?). John of Procida.

The Arabic Period, which began with the second destruction of the Alexandrian Library—640 A.D.—ends with the fourteenth century. At the commencement of this period the Roman Empire of the West scarcely existed: the magnificent territory which composed it had been overrun and subdued by barbarous tribes from the forests of the North, while from its ruins had risen several independent kingdoms,—that of the Franks in Gallia, of the Visigoths in Spain, and of the Lombards in Italy. The last of the Western emperors of note was Justinian, whose army and generals—especially the genius and heroic devotion of Belisarius—threw some glory upon Italy, Sicily, Africa, and Spain. Meantime the Empire of the East, surrounded by enemies, and harassed from all directions, still sustained itself with vigor. The Turks had begun to show themselves on the banks of the Danube; those eternal enemies of Rome—the Persians—made incessant war; and a new and terrible enemy had sprung up in the deserts of Arabia. Then came one who was at the same time legislator, prophet, and conqueror, and united under one faith and one leader tribes hitherto divided and warring against each other. Thus arose a powerful and enthusiastic nation, animated by thirst for conquest and ardor for proselytism. In less than a century after the first preaching of Mahomet, all of Arabia, India, Syria, and Egypt were in the hands of his followers. In the year 640 Amrou effected the conquest of Egypt, seized Alexandria, and the great library of five hundred thousand volumes was, by order of Omar (successor to Mahomet), delivered over to the flames; and the historian Abulpharagius declares that these books served for six months to heat the public baths, four thousand in number. Such were the first fruits of the establishment of Islam. * Happily, zeal of proselytism somewhat abated among the Mussulman princes, and religious fervor gave place to policy; so that the later Arabian caliphs showed themselves, in general, the protectors of the arts and sciences. Some, indeed, endeavored to collect the dÉbris of the scattered treasures that had been so fortunate as to escape the ignorant fanaticism of their predecessors; and others, more tolerant even than the Christian princes of the time, received without distinction all men of merit who took refuge in their State, gave them employment, and recompensed them for their services. On this account philosophers and persecuted "heretics" sought an asylum among infidels, and found there the protection which Christianity did not afford,—in return for which they gave their protectors the benefits of Greek civilization.

Of all the Moslem rulers, the most distinguished for love of learning and general enlightenment was Haroun-al-Raschid, the Charlemagne of the East, contemporary and emulator of the glory of the emperor of the Franks, the hero of a hundred Arabic poems, whose dominion extended from the borders of the Indus to the heart of the Spanish peninsula. He embellished Bagdad, his capital, with schools and hospitals. His son Almamon founded the Academy of Bagdad, which became the most celebrated of the age; likewise spared no pains to draw to his court the most illustrious men of all countries. He enjoined each of his ambassadors to purchase all the writings of the philosophers and physicians that could be found, and these he required to be translated into Arabic; his interpreter, Honain, a Christian, was employed at translating for forty-five years, and received, for each book rendered into Arabic, literally its weight in gold.

The eclat which the Moorish caliphs shed upon Spain from the tenth to the thirteenth century is well known. The cities of Cordova, Toledo, Seville, and Murcia possessed public libraries and academies, and students from all parts of Europe flocked to them to be instructed in arts and sciences; the library of Cordova alone embraced more than two hundred and twenty-four thousand volumes. Thus it will be seen that the dominion of mental and temporal affairs passed from the Greeks and Romans to the Saracens.

Arabian medicine constitutes one of the most interesting chapters in the history of our art. An offspring from Greek schools, it was for nearly one hundred years the fostermother of that art, and, although it gave rise to no great discovery nor wonderful step in advance during all this period, it nevertheless kept alive all the learning of the past, and clarified rather than made it turbid. In the sixth century the Nestorians (followers of Bishop Nestor), having been driven out of Syria, settled in Persia, Mesopotamia, and Arabia, and there founded schools and other institutions such as they had had at home,—schools in which, beside the ordinary philosophic studies, medicine received a share of attention. Thus it came about that by the seventh century Arabian physicians were everywhere known and in high repute. Naturally the basis for their studies embodied the writings of Hippocrates, Galen, Oribasius, and Paul of Ægina; and the first Arabian works consisted solely of translations from the Greek, first out of their Syriac rendering, and later from the originals. Indeed, so much eminence was finally achieved by Arabian physicians that more than four hundred are known by name as authors.

The first author deserving of mention was Bachtischua, of Nestorian stock, celebrated in Jondisapur, director of the medical school, and later physician to Caliph El-Mansur, in Bagdad. Of his descendants several became well known in the same field.

Alkindus—this being the Latin arrangement of his Arabic name—came from a Persian family, who lived first in Basara and later at the court of the caliphs El-Monon and El-Motasin, in Bagdad. He enjoyed a very high reputation as physician, philosopher, astronomer, and mathematician, and died A.D. 873. Mesue, the first of his name, sometimes known as Janus Damascenus, was director of the hospital in Bagdad and physician to Haroun-al-Raschid. He was born in 777, wrote extensively (since at least forty of his works have been catalogued), and died in 857 in Samarra.

Serapion the elder, also sometimes known as Janus Damascenus, and whose Arabic name was Serafiun, was born in Damascus—the exact data is not known—and died some time prior to A.D. 930. He was author of two volumes of aphorisms concerning the practice of medicine, which had at his time the greatest repute.

The most celebrated of the early Arabian physicians was Rhazes, born in the Persian province of Khorassan A.D. 850. According to the historians of his nation he was a universal genius, equally famous in music, astronomy, mathematics, chemistry, and medicine; he was surnamed "The Experienced." At the age of fifty he was one of the most distinguished professors in the Academy of Bagdad, where students came from great distances to listen to him. Chosen from among a hundred colleagues to direct the grand hospital of that city, he displayed indefatigable zeal and most scholarly learning, even to his old age and in spite of loss of sight, which overtook him at the age of eighty, when his reputation was at its height. Two years after this misfortune—i.e., in 932—he died. His generosity, which was proverbial, and his compassion for the poor left him penniless at the time of his death. Some two hundred and thirty-seven monographs of his have been catalogued, though the greater number of his works are practically lost. Two treatises on medicine remain which afford excellent counsel in many respects; among other matters he advises:—

"Study carefully the antecedents of the man to whose care you propose to confide all you have most dear in this world,—that is, your life and the lives of your wife and children. If the man is dissipated, is given to frivolous pleasures, cultivates with too much zeal the arts foreign to his profession, still more if he be addicted to wine and debauchery, refrain from committing into such hands lives so precious."

His greatest publication was Continens—extracts compiled from all authors for his own use—divided into thirty-seven books, constituting an abridgment of the science of medicine and surgery up to his time; and, notwithstanding its imperfect state, this work was held in greatest reverence, and was a common source of knowledge among Orientals long after his day.

Haly-Abbas, a Persian by birth, flourished fifty years after Rhazes, and died A.D. 994. His Almalelci, in twenty volumes, constituted a quite complete system of theory and practice of medicine, which, however, was in large measure taken from Rhazes's Continens. It is generally regarded as the best work of any of the physicians of the Arabic Period; it is divided into three parts—a book on Health, a book on Death, and a book of Signs—and it is interesting to know that the portion devoted to midwifery and obstetrics was in the hands not only of the profession, but also of the midwives.

Avicenna—Latinized form of his Arabic name, Ebn Sina—was born in Bokhara in 980. From his earliest youth he manifested a remarkable disposition for scientific study, and it is claimed that he mastered the entire Koran at the age of ten years; also that he devoted his entire days and the greater part of his nights to research, mastering philosophy, mathematics, astronomy, and, later, medicine, which he studied at the university at Bagdad, in which city his talents were chiefly exhibited. He was received at court, loaded with favors, and elevated to the dignity of Vizier, but suddenly fell into disgrace, was deprived of property, imprisoned, and even threatened with execution. After two years, however, he was restored to liberty, and once more possessed the consideration of the public and the court, becoming the recipient of new honors. Meantime he had given himself up to intemperance, by which his previously robust constitution was undermined, and this, with excessive labor, brought about his demise at the too early age of fifty-six, in the year 1037. He was author of several books, the chief being the Canon Medicinae, which remained a classic for six centuries, constituting the medical code of Asia and Saracenic Europe; no author since Galen had enjoyed so wide and extensive authority in the medical world; and in the various medical schools professors, for the most part, confined themselves to reading the Canon from their desks, explaining and commenting upon its text. The work was divided into five volumes, of which the first two comprised the principles of physiology, pathology, hygiene, and therapeutics, arranged to conform to the teachings of Aristotle and Galen; the third and fourth dealt with treatment; and the fifth wras devoted to the preparation and composition of remedies. Avicenna appears to have surpassed in subtlety both Aristotle and Galen; he was fond of metaphysical speculation, and his works were too much filled out with subtleties of language rather than with true science. Authors of this period were fond of torturing in every way possible the writings which they undertook to edit or quote from, and, instead of devoting themselves to original research, wasted time in seeking for vague and hidden meanings. That man was most esteemed as learned who could see the greatest subtlety in some passage from one of the ancient writers; consequently, that which was obscure or unintelligible was deemed the most sublime and philosophic. A very brief study of the Canon, for instance, will show this, while in graphic pictures of disease the work by no means approaches those of AretÆus or Alexander of Tralles, for Avicenna too often contented himself with mentioning merely a list of symptoms without indicating in any way their progression, characters, or duration. Undoubtedly just was the criticism of an Arabian poet: "His philosophy had no sound foundation, and his medical knowledge availed him naught for the possession of personal health and long life."

Albucassis was born in Zahra, near Cordova, about the beginning of the eleventh century, and is supposed to have died A.D. 1122, at the advanced age of one hundred and one. He was author of an abridgment, or compilation, devoted to the practice of medicine, the only novelty of which is a small portion devoted to surgery, in which are described certain instruments. He says:—

"I have detailed briefly the methods of operations; I have described all necessary instruments, and I present their forms by means of drawings; in a word, I have omitted nothing of what can shed light to the profession.... But one of the principal reasons why it is so rare to meet a successful surgeon is that the apprenticeship of this branch is very long, and he who devotes himself to it must be versed in the science of anatomy, of which Galen has transmitted us the knowledge.... In fine, no one should permit himself to attempt this difficult art without having a perfept knowledge of anatomy and the action of remedies."

Not a word is said about dissections, however, from which we conclude that they were not tolerated in his time. He resorted enthusiastically to the cautery, and recommended it in spontaneous luxations and the commencement of curvature of the spine. He refers particularly to instrumental delivery and the extraction of the after-birth, and, when speaking of fractures and dislocations, he remarks: "This part of surgery has been abandoned to men of vulgar and uncultivated minds, for which reason it has fallen into undeserved contempt."

Avenzoar, born in 1113, of a Spanish family which had many illustrious scions, was instructed in medicine by his father, and ultimately achieved great celebrity throughout Spain and Africa; for a time he lived at the court of the Prince of Seville, loaded with honors and presents, and finally was made Vizier. Among other works he wrote a treatise on renal diseases, in which he outlined the treatment of calculus and described an operation therefor. He died in 1161.

AverroËs (as he is generally known, though his Arabic name was Aben Roschd) was born A.D. 1166, in Cordova, where his father held official position. After being grounded in philosophy, mathematics, and other sciences he became a pupil in medicine under Avenzoar. The greater part of his life wras passed in Seville, where he was greatly esteemed and finally knighted. In 1195 he was called to the court of the King of Spain and Morocco, in Cordova, where he received the highest honors, only, however, through some misunderstanding, to be disgraced; but he soon afterward recovered his former position and dignities. He wrote extensively not only on medicine, but on philosophy, his writings taking throughout a more or less dialectic character. He died in 1198, and from him descended a number of physicians who achieved more or less reputation.

Maimonides was born in Cordova, A.D. 1135. He early devoted himself to the Talmud, and in his extended travels visited Jerusalem; he even founded a school of philosophy in the East, which, however, had only a brief existence. He died in 1204. He ranked higher in philosophy than in medical art, and seems to have been imbued with the methods of his teacher, AverroËs, and is generally regarded as a theorist rather than as a practical physician, although he wrote more or less on medical topics, and is particularly remembered for an essay upon poisons. He was about the last of the Arabians who deserves special mention.

During the period which was nearing its close at the time of the death of Maimonides, the Arabs embraced with much ardor the study of medicine, and translated into their language nearly all the treasures that had been amassed by the Greeks; indeed, the preservation of many of the great writings which would otherwise have been lost is due solely to this fact. Strange to say, however, the Arabians neglected Latin authors, and apparently possessed no knowledge of Celsus or Coelius Aurelianus. As religious prejudices prohibited dissections, they were obliged to rely solely upon the anatomical descriptions of Galen, and succeeded in increasing the errors of the original by inaccurate translations. So far as originality of observation goes, the Arabians were in most respects behind the Greeks; nevertheless, they were the first to differentiate eruptive fevers, to which the latter paid little or no attention. The Arabian school also supplied the knowledge of purgatives, such as cassia and manna, which replaced the drastics employed by the ancients; also the mode of preparation of syrups, tinctures, distilled waters, pomades, and plasters.

While the Arabians were gradually rising by their power, intelligence, and renown, the Greeks were declining in inverse ratio; the genius, courage, and ancient virtues of the latter grew weaker and weaker, until they seemed on the verge of extinction. In the medical history of these centuries, in all Europe not under Moslem rule, there was but one man entitled to mention as an author in medicine,—viz., John Actuarius, the son of one Zacharia. He lived at the close of the thirteenth and the beginning of the fourteenth century; was employed at Constantinople, his surname being the honorary title of the court-physicians. He is more commonly known as Zacharia. Of his life we know little, save that he wrote several volumes, for the most part abridgments or commentaries on the doctrine of Galen. He laid great stress on the theory of critical days, and sustained his views by astronomical hypotheses most ingeniously combined. His was the first Greek work in which were mentioned the remedies introduced by the Arabians, yet he has not a word to say of variola, measles, spina ventosa, and other affections fully described by Arabic authors. He held remarkable views concerning the nature of man, whom he supposed to be formed by the union of two contrary substances,—the soul and the body; described somewhat elaborately an imaginary plexus of veins connected with the digestive organs, through which the animal spirits were elaborated and purified; also, and quite methodically, for his age, he explained the functions of the animal economy and the etiology of disease.

While the clouds that befogged the study of medicine in the Empire of the East thus grew heavier and heavier, we must not be blind to the melancholy spectacle concerning the provinces composing the Empire of the West. Barbarians in swarms, from the forests of Germany and Scandinavia, had swept its various portions, pillaging, destroying, and reducing to slavery its inhabitants. In southern Europe everything was changed. Each generation witnessed some new and unheard-of invader, who demanded his share of booty and renown and left a track of desolation behind him. There was a brief period of order when Charlemagne reunited under one dominion these divers races and seemed to have resuscitated the Western Empire; but no sooner was he dead than its elements, being devoid of affinity, broke apart. Former vassals, no longer restrained by the firm hand of the emperor, made common warfare against his successors and against each other, and for several ages there was nothing but a succession of wars and invasions. Feudalism gave some sort of character to this military anarchy by affording repose and, in a measure, security for those who had hitherto been trampled under foot; but learning and the sciences fell into complete neglect, and it was with great difficulty that a very small number of men found within the pale of the church a limited protection that enabled them to devote themselves to the study of medicine and ecclesiastical law. Near the end of the eleventh century, however, the enthusiasm of the crusades whetted anew the turbulent appetite of the Christian barons, and led these lords of western Europe, with their belligerent spirits, to the East, as a result of which people hitherto oppressed could breathe more freely. A few States recovered their independence; some semblance of law was established; municipal institutions were organized, and establishments consecrated to public use were founded and multiplied; finally, in the course of the thirteenth and fourteenth centuries, the cloud which covered the face of Roman Catholic Europe was in some measure dispersed, and men of talent and even genius began to appear upon the scene; everything about them being so obscure, they shone like stars in the firmament. In letters, for instance, there were Dante, Petrarch, Boccaccio; in mathematics, Leonard, of Pisa, the first in Europe to understand and employ figures and algebraic characters, although Cuvier has claimed this distinction for Gerbert, a Benedictine monk of the tenth century, who subsequently became Pope Sylvester II. At this time, although in scholastic estimation medicine, theology, and philosophy alone were fit to entertain the human mind, the natural sciences were not without occasional representatives. Roger Bacon was three centuries in advance of scientific reform, and endeavored to introduce experimental philosophy, and so fully convinced some of his auditors that they subscribed £2000 sterling to provide for the expense of his experiments; this was money most happily employed, since it made possible a number of important discoveries. It is said that Bacon knew the properties of convex and concave lenses, and was the first to conceive of the microscope and telescope; his astronomical knowledge led him to demand a reform in the calendar, which Gregory XIII carried out three centuries later; he had knowledge of gunpowder and its effects, and was, in fact, the wizard of his day; but his boldness and originality drew upon him the enmity of the church, by which he was persecuted and finally condemned to imprisonment for life upon a diet of bread and water, although he was ultimately released, in 1266, by Pope Clement IV. He wrote extensively, but only fragments of his works exist, since the friars believed them tainted with witchcraft and prevented their publication.

Before and during the time of Roger Bacon the philosophers were divided into two parties, which engaged in very unseemly and unphilosophic strife. One was termed the Realist, and believed, with Plato, that ideas are self-existent and independent of the mind,—in other words, veritable entities; the other, the Nominalist, held, with Aristotle, that general ideas are pure abstractions formed by the mind with the aid of sensations received from without, without which they could never exist,—that is, if a being could be imagined without sensibilities and the power of sensation, such being would be destitute of ideas. These two parties kept up a very active warfare, and enlisted the aid of both civil and ecclesiastical authorities, the result being persecution of each other, and that general unsatisfactory conflict into which theology and metaphysical speculation always force those who indulge in them.

Now, regarding the condition of medical affairs in the Empire of the West: Down to the seventh century, in Rome, there were court-archiaters who were attached to the retinues of the nobles, and in each large city popular archiaters formed a college charged with sanitary matters, the instruction and examination of candidates, and gratuitous services to the poor. Although there is little definite information available, it is probable that after the ruin of Alexandria much the same medical organization obtained in those provinces as continued under the Greek Empire at Constantinople. Under Arab sway we know very little of what rules or regulations governed instruction in medicine and its practice; and, so soon as one of these countries fell under the rule of the Turks, all scientific institutions seem to have decayed or been discontinued,—or, as Renouard states it: "If we may judge by what still exists to-day in this unfortunate country (Turkey), consumed by the power of ignorance and despotism, the most complete anarchy followed all older organizations."

In southern Europe, however, things had not gone on quite so badly, although at first barbarous invasion caused everywhere disorder and confusion, and the Christian States of the Western Empire yet presented after three or four centuries a chaotic condition of affairs. The ecclesiastical schools, which were under the care of the church, still pursued courses of literary and scientific instruction; in the time of Charlemagne, for instance, the colleges of the cathedrals, and even some of the monasteries, taught medicine in a very limited way under the name of physics. Thus all the liberal professions—that of medicine included—fell under the domination of the clergy, and priests, abbots, and bishops became court-physicians. The monks of Mount Cassin, of the order of St. Benoit, enjoyed for a long time a great reputation for medical skill; and among these in the tenth century was an abbot named Berthier Didier, who became Pope Victor III toward the close of the eleventh century, and one Constantine, surnamed the African. Of the ecclesiastics who from the ninth to the eleventh century were distinguished by the knowledge of medicine, there were Hugues, abbot of St. Denis, physician to the King of France; Didon, abbot of Sens; Sigoal, abbot of Epernay; Archbishop Milo, etc. Even several religious orders of women undertook, to a certain extent, the practice of medicine, and Hildegarde, who was abbess of the convent of Rupertsburg, near Bingen, is credited with having written a treatise on Materia Medica.

From the ninth to the thirteenth century the Jews shared with the clergy the monopoly of the healing art. Many of these studied under Arabian physicians, and, though the canons of the church forbade them to in any way minister to the ailments of Christians, they were still called upon in time of need, and even in many instances had access to the palaces of archbishops, cardinals, and popes.

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:

If thou to health and vigor would'st attain,

Shun mighty cares; all anger deem profane;

From heavy suppers and much wine abstain;

Nor trivial count it after pompous fare

To rise from table and to take the air.

Shun idle noonday slumbers, nor delay

The urgent calls of nature to obey.

These rules if thou wilt follow to the end,

Thy life to greater length thou may'st extend."

During the twelfth and thirteenth centuries the glory of the School of Salerno reached its zenith; it was the most famous school of medicine in Europe, and was fostered by various kings. The celebrated Jew, Benjamin of Tudela, traveling from Spain to India, visited Salernum in 1164, and called it the "principal university of Christendom." Early in the twelfth century flourished Cophon, Archimatheus, and Nicholas, surnamed PrÆpositus, all of whom were distinguished teachers. The latter published a work known as Antidotarium, which was for several centuries the standard pharmacopoeia, and which contained a table of weights that corresponded very closely to those of the modern apothecary. The younger Cophon, who has been confounded with his father (as both seem to have written extensively), wrote two treatises,—one on the anatomy of the hog, the other entitled Ars Medendi. The first is interesting as the only anatomical treatise of this school which has been preserved, and is an index of the degradation of anatomical science of that time.

The names of John and Matthew Platearius are of frequent occurrence in the records of this school, and have given rise to considerable confusion; the former is supposed to have been the husband of Trotula, a female physician, of whom I shall have more to say later.

Bernard the Provincial, who seems to have escaped the notice of most historians, wrote about 1155, and his commentary offers much interesting information concerning the therapeutics of the day; he formulated a large number of recipes to enable the sick to escape the omnipotence of the apothecaries, and recommended wine for the delicate stomachs of the more exalted of the clergy, and, inasmuch as these stomachs did not bear medicine well, he directed, in accordance with the practice of Archbishop Æfanus, that emetics should be prescribed after meals, when their action is less injurious and more agreeable; he advised young men and women tormented with love which they could not gratify to tie their hands behind their backs and drink water from a vessel in which a red-hot iron had been cooled. Indeed, his work is full of curious information and advice, and is not without therapeutic interest.

A name which figures largely in the history of this school is that of Magister Salernus, about which there is great uncertainty; it is not positively known whether this refers to a particular person or is a generic name covering various individuals. The name has been mentioned as that of one of the four reputed founders of the school; it is positive that there are certain treatises which bear this name, which give an appearance of authenticity to it as an individual title.

In the latter half of the twelfth century lived John of St. Paul, one of the teachers of Gilbert the Englishman; also Musandinus, who left a curious treatise on dietetics; and Urso, who wrote on the pulse and on the urine. Here in 1190 resided and studied a certain Alcadinus, from Syracuse, whose knowledge of philosophy and medicine was such that he acquired great reputation, and was made a professor; he even composed Latin medical poems.

Just at the close of this century flourished Ægidius, who studied at Salernum, and also at Montpellier, where a school of medicine had been founded in 1180; he was physician to Philip Augustus, of France, and became professor in the University of Paris. Three treatises, all in Latin hexameter, are ascribed to him. A contemporary was Johanes Rogerus, of Palermo, a graduate of Salernum and author of several works.

Early in the thirteenth century flourished Roger of Parma, one of the most distinguished of the alumni of this school and the earliest pioneer in modern surgery; his work on this topic, familiarly known as Rogeriana, enjoyed the greatest reputation in its day, and was for a long time the surgical text-book of Italy; his predilection for poultices and moist dressings in the treatment of wounds, abscesses, and ulcers became, in the hands of his successors, the distinguishing feature of the surgery of Salernum in opposition to the school at Bologna, where Hugo Di Lucca and Theo-doric (his great rival) contended for the superiority of the dry treatment. Roger was also the first to use the term seton, and to give practical demonstration to this means of derivation.

Roland of Parma, a pupil of Roger, and a surgeon of great distinction, became professor at Bologna, and wrote a treatise on surgery, which was, for the most part, a commentary on the works of his master. The treatise of Roger and that of Roland furnished the basis for a work entitled The Treatise of the Four Masters, supposed to have been written about 1270, and manuscripts of which have been long known in various European libraries. It is divided into four books, displays no little surgical ability, and from its title would appear to have been the joint composition of four teachers; indeed, it was long attributed to Archimatheus, Platearius, Petro Cellus, and Affiacius, though it is now pretty generally understood to be the product of but a single pen and its author most likely a Frenchman. The ascription of authorship to four masters was probably for the purpose of increasing its weight and authority, and it constituted a reliable exposition of the surgery of Salernum in its day. It is quoted quite freely by Guy de Chauliac, who was the restorer of French surgery in the fourteenth century, and occasionally by later writers.

Another of the distinguished Salernian physicians of the thirteenth century, one highly esteemed by Frederick II, was John of Procida, who also was active in producing—if not the real author of—the massacre of the Sicilian Vespers, A.D. 1282. In a dispute concerning the question of the two Sicilies he embraced the cause of Prince Manfred, for which he was banished by Charles of Anjou, and took refuge at the court of Peter III, of Arragon, by whom he was created a baron; and he was influential in persuading the latter to assert his claim to the throne of Sicily. By various intrigues at different courts he succeeded in organizing an alliance, which betrayed its existence in this massacre, and finally resulted in the overthrow of the French in Sicily and the transfer of the island to the crown of Spain. He was author of at least two treatises devoted to medicine and philosophy.

Other writers of the School of Salernum were: a learned Jew of Agrigentum known as "Farragus," Matthew Sylvaticus, GraphÆus, and Cappola. About the middle of the fifteenth century flourished Saladino, famous as an authority on materia medica.

It is of no small interest that now, for the first time in history, women began to figure somewhat prominently as writers, practitioners, and even teachers of medicine. About the middle of the eleventh century appeared a work, entitled De Midierium Passionibus, attributed to the before-mentioned Trotula, wife of John Platearius, which has descended even to these days. There is nothing in the work to indicate the name or sex of the author, who is invariably spoken of in the third person; consequently Trotula's connection therewith has often been disputed.

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.