James A. Marcum, PhD
Baylor University, Waco, Texas, United States (Summer 2012)
Schola Medica Salernitana from
Avicenna’s Canon of Medicine
The naissance of Schola Medica Salernitana, or the medical school at Salerno, on the Italian southwest coast is shrouded in myth and controversy. According to one tradition, the school’s beginning dates to Parmenides, a pre-Socratic philosopher who, in 540 BCE, founded a medical school in the Greek colony of Elea (called Velia in Latin), located on the coast eighty kilometers south of Salerno. Within this tradition, the medical college at Velia was transferred intact to Salerno. According to another tradition, the school’s origin involved the labor of four founders—Pontus, a Greek; Salernus, a Latin; Adela, an Arab; and Elinus, a Jew—each representing the various cultural influences on the school throughout its history.
What is fact and undisputed is that Schola Medica Salernitana had a major impact on the revival and development of Western medicine. That impact began in the early ninth century when a Benedictine monastery hospital or dispensary opened in Salerno; by the end of the century physicians trained at the medical school were in demand. The medical foundation of the Salerno school was Greek in origin, with Latin translations of both Hippocrates’ and Galen’s writings dominating the medical school curriculum. Constantinus Africanus (ca. 1020–1087 CE), who used Arabic sources, was chiefly responsible for these translations. In addition, many of the school’s faculty wrote, often anonymously, important treatises on the practice of medicine, which advanced the school’s reputation. The school flourished from the tenth to twelfth centuries, reaching in the twelfth century its apogee of influence on medicine throughout the known world. By the twelfth century, Salerno merited the title of Hippocratica civitas or city of Hippocrates—as depicted today in its coat-of-arms. One of the crowning achievements of the school was a poem on health, “Regimen Sanitatis Salernitanum.”
Just as the founding of Schola Medica Salernitana is controversial and uncertain, so is the origin of the Regimen Sanitatis, or “The Book of Health.” Tradition ascribes the poem’s inception to an anonymous author from the Salerno school during the twelfth century, but recent scholarship contests this genealogy. The original poem was only 362 verses and dealt with diet and hygiene in an opening section, with subsequent sections addressing medicinals or material medica, bodily structure and functions, and treatment options. The poem eventually grew to a final version of 3,520 verses, with the accrual of additional verses on the above topics, as well as on other topics such as disease etiology, pathology, nosology, and semiotics. The poem opens with a dedication to an English king, who, according to tradition, is Robert, the son of William the Conqueror (ca. 1028–1087 CE). The king’s son came to Salerno from the Crusades to have a fistula attended. He left with the fistula healed and with a copy of the poem. The poem is not a theoretical manual of medical practice, but rather a practical guide for procuring and maintaining health and well-being. The opening lines of the poem provide an ample summary of its advice towards that end:
Regimen Sanitatis Salernitanum, ca. 1480
The influence of Hippocrates and Galen are evident throughout the poem, especially in terms of the four humors of disease and health. The poem also gives advice on bloodletting, particularly the best months for conducting the procedure. The influence of the poem is evident from its wide dispersal, with over one hundred known versions and three hundred printed editions.
During the twelfth century, however, a major shift in medicine occurred with the introduction of an Islamic medicine that emphasized the role of critical thought—based on experimentum or experience—in evaluating medical knowledge and practice, particularly in introducing botanical remedies to the medieval pharmacopeia. Islamic medical practitioners were no longer simply interested in commenting practically on the ancient Hippocratic or Galenic texts, but in evaluating them analytically from a theoretical perspective. In other words, the shift represents a move from simply amassing a practical compendium of previous advice and procedures for practicing medicine to fashioning a theoretical commentarium in which the medical faculty revised and expanded the compendium based on the its medical experiences and observations.
Nevertheless, the traditional position of Schola Medica Salernitana remained pragmatic throughout this shift, as evident from the Regimen Sanitatis. Indeed, the Salerno school faculty shunned and eventually rejected the philosophy of Islamic medicine, especially Avicenna’s Canon of Medicine, and held to the practical instructions of Greek and Latin antiquity. Uroscopy best illustrates the Salerno school with respect to rejection of Islamic medicine. For example, Tractatus de Urinis by Maurus Salernitanus (ca. 1130–1214 CE), the standard text for analyzing a patient’s urine and teaching students, was profoundly indebted to Galen’s De Urinis.
Although the philosophical approach to medicine at Schola Medica Salernitana remained bound to the Greeks and Latins, other institutions—such as the medical school at Montpellier—incorporated the Islamic approach to medical knowledge and practice. For instance, De Urinarum Judiciis by Aegidius Corboliensis or Giles of Corbeil (ca. 1140–1224 CE), a French physician who studied at Salerno, incorporated much of the Islamic spirit of natural philosophical investigation and observation to advance uroscopy; and, his work eclipsed Maurus’ text. Besides the Montpellier school, medical schools in Bologna and Paris also adopted the philosophy of Islamic medicine and led the charge to advance medical knowledge and practice.
The practical approach to medicine—based on traditional Greco-Roman medical philosophy—that fueled Schola Medica Salernitana’s earlier success became antiquated in the light of a new theoretical approach to medicine based on Islamic advances in natural philosophy. Irrespective of its allegiance to an outmoded philosophical approach to medicine, the Salerno school still occupies an important position in the development of Western medicine. Specifically, it was one of the first precursors—if not the first—to modern medical pedagogy and practice, especially in terms of providing a formal curriculum for teaching medical knowledge. Moreover, the literary output of the faculty alone would secure the school a significant position in the development of Western medicine. Besides its reputation for excellence in medical education and practice, the Salerno school also earned repute for the equal opportunities it afforded women to study and practice medicine. Although the impact of the Salerno school diminished over the centuries, beginning in the thirteenth century, the school did not officially close until 1811—certainly a testament to its importance in the history of medicine.
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JAMES A. MARCUM, PhD is professor of philosophy and director of the Medical Humanities Program at Baylor University in Waco, Texas. He earned doctorates in philosophy from Boston College and in physiology from the University of Cincinnati Medical College. He was a faculty member at Harvard Medical School for over a decade before coming to Baylor. His current research interests include the philosophy and history of science and medicine. His recent publications appear in Synthese, Perspectives on Science, History and Philosophy of the Life Sciences, Journal of the History of Medicine and Allied Sciences, Perspectives in Biology and Medicine, and Theoretical Medicine and Bioethics. His recent books are An Introductory Philosophy of Medicine: Humanizing Modern Medicine and The Virtuous Physician: The Role of Virtue in Medicine.