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.1

1It seems hard to understand how so useful an auxiliary to the surgeon as the ligature,-it seems indispensable to us, could possibly be allowed to go out of use and even be forgotten. It will not be difficult, however, for anyone who recalls the conditions that obtained in old-time surgery. The ligature is a most satisfying immediate resource in stopping bleeding from an artery, but a septic ligature inevitably causes suppuration and almost inevitably leads to secondary hemorrhage. In the old days of septic surgery secondary hemorrhage was the surgeon's greatest and most dreaded bane. Some time from the fifth to the ninth day a septic ligature came away under conditions such that inflammatory disturbance had prevented sealing of the vessel. If the vessel was large, then the hemorrhage was fast and furious and the patient died in a few minutes. After a surgeon had had a few deaths of this kind he