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ence, 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 contraindications, 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 fragmentary 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