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Keywords:

  • middleages;
  • birth defects;
  • Salerno;
  • Schola Medica Salernitana

Abstract

  1. Top of page
  2. Abstract
  3. INTRODUCTION
  4. SCHOLA MEDICA SALERNITANA. WHY DID IT FLOURISH IN SALERNO?
  5. THE LOCATIONS. WHERE WAS IT CENTERED?
  6. THE ORIGINS
  7. THE THEORIES
  8. CONCLUSIONS
  9. Acknowledgements
  10. REFERENCES

Ever since the 9th century during the High Middle Ages, the “Schola Medica Salernitana,” believed to be the first medical school in the western world, flourished in Salerno, a city in southern Italy. Although an important role is attributed to several men of this school, who were recognized as wise and learned doctors, modern historiography has also reevaluated and extolled the praiseworthy role of women. Contrary to the common beliefs and expectations of a woman's “place” at the time, these women were fully titled physicians. Attention was also paid to the health and welfare of children. However, there are no apparent references to physical disabilities, a mysterious omission that seems incompatible with an institution that stood as a beacon of knowledge for centuries. Mysteries, discoveries, and potential hidden messages are mingled in a fascinating medieval codex yet to be fully deciphered. The medical school reached its maximum splendor between the years of 1000 and 1300 AD. After alternating fortunes, the Salernitan institution began a slow decline due to the explosive development of other universities, such as those in Paris, Bologna, Padua, and most significantly, the nearby University of Naples. It was eventually closed by the King of Naples, Joachim Murat, November 29, 1811. © 2013 Wiley Periodicals, Inc.


INTRODUCTION

  1. Top of page
  2. Abstract
  3. INTRODUCTION
  4. SCHOLA MEDICA SALERNITANA. WHY DID IT FLOURISH IN SALERNO?
  5. THE LOCATIONS. WHERE WAS IT CENTERED?
  6. THE ORIGINS
  7. THE THEORIES
  8. CONCLUSIONS
  9. Acknowledgements
  10. REFERENCES

Salerno is a city in southern Italy a few kilometers from the more famous, important, and extraordinary city of Naples (Fig. 1). Salerno is situated near the center of an equally beautiful bay of the same name, which extends north to the jagged, austere Amalfitan coast and south to the Cilentan coastal plain rich in maritime pine and olive trees. The city experienced its maximum splendor between the VIII and IX centuries, with Duke Arechi II, who in 787, for political, commercial, and strategic reasons, moved the capital of the Duchy Longobardia Minor from Benevento to Salerno. In this period commerce prospered, and literature and the arts flourished, as well as studies in law and medicine, with the Salerno Medical School being the first and most famous in the world at that time [De Renzi, 1857; Guitard, 1952; Kristeller, 1955, 1980; Moller, 1957]. Salerno also became the capital of the Norman Southern Italy (Mezzogiorno Normanno) under the Norman conqueror, Roberto il Guiscardo, who in 1076–1077, after a long siege, captured the city and put an end to the Lombard Duchy. Salerno retained this privilege until 1130, when Roger II became King of Sicily and moved his administrative base to Palermo. Even in modern times Salerno was the capital of the new Italian government, from September 1943 to July 1944, after the Allies landed in its gulf and a tough battle against the German forces was fought (Operation Avalanche, September 9, 1943).

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Figure 1. Salerno and its geographical location. [Color figure can be seen in the online version of this article, available at http://wileyonlinelibrary.com/journal/ajmga]

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SCHOLA MEDICA SALERNITANA. WHY DID IT FLOURISH IN SALERNO?

  1. Top of page
  2. Abstract
  3. INTRODUCTION
  4. SCHOLA MEDICA SALERNITANA. WHY DID IT FLOURISH IN SALERNO?
  5. THE LOCATIONS. WHERE WAS IT CENTERED?
  6. THE ORIGINS
  7. THE THEORIES
  8. CONCLUSIONS
  9. Acknowledgements
  10. REFERENCES

There are various reasons. The most logical explanation is that it is granted with an exceptional coincidence of historical, cultural, and geographic factors [Green, 2009].

The location of the city at the center of the Mediterranean fostered commerce with different cultures and made it a convenient meeting point between the Christian west and Muslim east. The coming to Salerno of the enlightened Prince Arechi II, who had surrounded himself with the best scholars and scientists of the time, made his court a center of refined culture.

Fundamental contributions were made by Salerno's Archbishop Alfano I as a physician, scholar and poet, translator, and author of the treatises, De quatuor umoribus and De pulsis. His contributions were made even greater for having lived for a long time in Byzantium, assimilating the culture and bringing home many codices. Under his influence and guidance, in 1076, Roberto il Guiscardo began the construction of the magnificent cathedral, the Duomo of Salerno, that houses the relics of Saint Matthew, to whom the cathedral is dedicated.

There were cultural exchanges between the Benedictine monasteries, and especially with the great monastery of Monte Cassino, where interest in medicine was noteworthy [Bloch, 1986]. We should acknowledge the ties between Archbishop Alfano I and Desiderius the Abbot of Montecassino who later became the Pope Victor III.

The arrival of Constantine the African from Carthage in 1077, enriched the scientific landscape of Salerno with a wealth of knowledge unknown in the West. In 1260, King Manfredi of Sicily instituted in Salerno a grand Fair and the construction of the seaport (the pier Manfredi, conceived and built by Giovanni da Procida), where wounded Crusaders landed from the Holy Land, to be entrusted to the school for medical care. Salerno produced the greatest “Maestri” (professors) of anatomy and surgery at that time, many of whom became authors of fundamental works that formed the foundation for generations of surgeons [Ladispoto, 1961; Tabanelli, 1965].

Finally, the location of the city itself, facing towards the sea and protected from behind by the Lattari Mountains played a role in the formation of the school. The sun shines and warms the winters and between streams of water that flow in the crevices of the cliffs and hills; there are grassy spaces where it is possible to create walled gardens, and where herbs and exotic plants can be cultivated (Fig. 2). The city is small but during the height of its splendor it possessed two dozen churches, and nine monasteries [Green, 2009]. And the monasteries, in those years, were really extraordinary, true centers of knowledge and study. In their gardens the monks cultivated medicinal plants, while in the infirmaries they attended to the poor and the sick. Care for the sick was one of the prerogatives of the Rule of St. Benedict: “The care of the sick is ahead of all and above all, for serving them is truly serving Christ” (I fratelli infermi, cap.36). From the 8th century, in every monastery there was a hospitium, a place where the sick were received, which in time became the infirmary, at the head of which there was a monachus infirmiarius. Annexed to the infirmaries were the armaria pigmentariorum, or apothecaries, where the plants grown in the gardens were preserved.

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Figure 2. Gardens of Minerva in the historic center of Salerno. [Color figure can be seen in the online version of this article, available at http://wileyonlinelibrary.com/journal/ajmga]

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Because of the interest and will of devoted princes and nobles between the IX and XI centuries, Salerno became filled with numerous churches and monasteries. The monastery of San Benedetto (Fig. 3) stands out among them as a shining beacon in the civil and religious history of the city with plenty of space and running water brought by an aqueduct (whose remains are still visible in Via Arce), and gardens (a botanical garden) for the cultivation of medicinal herbs. Nurses, created initially to treat sick Brothers of the monastery, soon also offered care to citizens and foreigners. Likewise the atrium of the Duomo of Salerno served as a sort of first refuge or “hotel” for pilgrims, travelers and the sick (Fig. 4).

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Figure 3. Interior of the Monastery of St. Benedetto in Salerno. [Color figure can be seen in the online version of this article, available at http://wileyonlinelibrary.com/journal/ajmga]

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Figure 4. The Cathedral of Salerno, the atrium, porch, and bell tower. [Color figure can be seen in the online version of this article, available at http://wileyonlinelibrary.com/journal/ajmga]

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THE LOCATIONS. WHERE WAS IT CENTERED?

  1. Top of page
  2. Abstract
  3. INTRODUCTION
  4. SCHOLA MEDICA SALERNITANA. WHY DID IT FLOURISH IN SALERNO?
  5. THE LOCATIONS. WHERE WAS IT CENTERED?
  6. THE ORIGINS
  7. THE THEORIES
  8. CONCLUSIONS
  9. Acknowledgements
  10. REFERENCES

Debated is the question of the location of the institutional seat of this medieval University of Salerno, Studium Salernitano [Capasso, 1923; Sinno, 1923]. Evidently it was not in only one place, but varied in different eras. Originally, the location or locations were in the upper parts of the city, on the slopes of Mount Bonadies, where there was an abundance of springs and streams that promoted the growth of lush gardens and orchards and the cultivation of medicinal herbs. In the new part of the city, Plaium Montis, arose the first hospice/hospital in what used to be the residence of Guaiferio, Prince of Salerno. It was operated by the Benedictine monks. In that same area, near its walls, arose a botanical garden, the oldest in Europe, owned by Matthew Silvatico, a doctor engaged in teaching at the school. He had amassed a deep knowledge of the therapeutic virtues of plants during his travels in the Far East, and wrote a work called Opus pandectarum medicinae, a lexicon, consisting of 721 chapters, 487 of which dealt with plants. The plants were denoted by their names (from Latin, Arabic, and Greek), and their morphology was described in detail, based either upon the classics or his own experience of their nature and healing properties. Because of his fame, he became the trusted physician for Roberto D'Angiò, King of Naples.

It is probable that in the beginning, the School was tied to the monasteries since most all of them were equipped with an infirmary where students had the opportunity to practice. The “private schola” was probably located in the professors' homes or perhaps in churches or noble palaces. For example, one of the buildings that scholars recognized in the teaching of medicine was in Martuscelli Palace on the Largo Scuola Medica Salernitana. Lessons were also held in ancient Pretura (Magistrates Court), on the street named Trotula De Ruggiero, in the church of Santa Maria della Porta and in the Cathedral itself. The graduation ceremony for doctoral students was held, at that time, in the Palatine Chapel of San Pietro a Corte (Fig. 5) and that of Santa Catherina d'Alexandria, patron saint of the School of Salerno in a room located on the south side of the portico of the Cathedral. The seat of the final school, before its closure, was at the Archbishop's Seminary.

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Figure 5. Palatine Chapel of St. Peter's Court where degrees were conferred in the High Middle Ages. [Color figure can be seen in the online version of this article, available at http://wileyonlinelibrary.com/journal/ajmga]

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THE ORIGINS

  1. Top of page
  2. Abstract
  3. INTRODUCTION
  4. SCHOLA MEDICA SALERNITANA. WHY DID IT FLOURISH IN SALERNO?
  5. THE LOCATIONS. WHERE WAS IT CENTERED?
  6. THE ORIGINS
  7. THE THEORIES
  8. CONCLUSIONS
  9. Acknowledgements
  10. REFERENCES

When was the medical school founded? A legend that has been handed down [Kristeller, 1955] claims that there were four Maestri that founded the school: a Latin (Salernus), an Arab (Adela), a Greek (Pontus), and a Hebrew (Helinus), perhaps metaphors for the cosmopolitan soul of Salerno in those days. The origin of the medical school is obscure. In the absence of adequate written testimony, it is difficult to ascertain whether its original character was secular or monastic-clerical. Nonetheless, as in other towns in the Western world, it is probable that the school was most likely connected to monastic institutions (oblates or clerics), and often the practice of medicine was carried out also by outside students. The enactment of the Costituzioni di Melfi by Frederick II in 1231, sanctioned, among other things, that “No one should dare to exercise the profession of physician or surgeon, unless he has been publicly examined by the Maestri of Salerno.” Before that, it was not easy to find other schools tied to greater Maestri, and it was much more than just an institution or a school with organized teaching and the awarding of degrees.

That view was in part supported by the English chronicler, Orderico Vitale (1075–1143), who wrote that “in Salerno since ancient times resided the most important school of medicine” and from Benjamin of Tudela, a Hebrew who came from the Navarre to Salerno around the middle of the 12th century, and described it as “urbem medicorum scholis illustrem.”

Some scholars trace the birth of the medical school to the 9th century, although there is no valid proof to support that date. Perhaps at the foundation of its development were the relationships interwoven with the Greeks during the Byzantine period. From the chronicles we know that in the year 946 a doctor from Salerno was invited for his great fame to the court of the king of France where he met the Bishop of Amiens, Deroldo.

Already in the second half of the 9th century people from the nearby cities were going to Salerno for treatment. Even before the year 1000, the city was rich with doctors, in large part Benedictine (there was already a Benedictine monastery at the end of the 8th century founded by Prince Grimoaldo). Above all, the collection of the Summae of medical writings prior to the 11th century was due to the Benedictine monks that did not live in the city.

At the end of the 10th century the fame of the Schola Salerni had already crossed the borders; in fact, written in an ancient French chronicle was the account that in 984, Adalberone, Bishop of Verdun, from France went to Salerno to receive treatment by renowned doctors of Salerno. Even Desiderius, Abbot of Monte Cassino, in 1050 traveled to Salerno for treatment of a consumptive disease. Romualdo Guarna, archbishop of Salerno from 1153 to 1181, described it as “artis medicinae famosam atque praecipuam diu” (prevalent and famous in the art of medicine).

The 12th century was one of major developments; belonging to that period was the richest production of literature, and medical and scientific collaboration with the city of Montpellier, that continued until the 16th century. Gilles de Corbeil, a doctor at the School of Salerno and student of Musandino to whom he dedicated his book in the verses of “De urinis,” reproached French colleagues following a lively debate that the School of Montpellier had not yet reached the level of that of Salerno. Other French doctors over the course of years would come to study in the Hippocratica Civitas (the city of Hippocrates).

Following edicts (Rheims 1131), which forbade the clergy to exercise outside the monasteries, the clergy lost control over the Stadium Salernitano, which acquired a secular character. The teaching becames more organic with the constitution of a regular medical college that had the power to issue diplomas in medicine valid throughout Europe.

Since 1231, with the recognition of Frederick II, the Studium Salernitano was authorized to confer degrees in medicine, surgery and philosophy, as well as licenses to operate a pharmacy [Lauriello, 2005]. At the end of the 13th century St. Thomas wrote about the wise city: “Quatuor sunt urbes caeteris praeminentes: Parisius in Scientiis, Salernum in medicinis, Bononia in legibus, Aurelianis in Actoribus,” that is, there are four preeminent cities, Paris in the sciences, Salerno in medicine, Bologna in law, Orleans in the actors' arts [Amelio, 1996].

Conrad IV, the successor of Frederick II, exhalted Salerno as “antiqua mater ed domus studii.” Thanks to the most popular of his books, the Regimen Sanitatis (the first printed edition in circa 1480), at the end of the 15th century Salerno was known throughout Europe, a claim that extended to the 18th century.

THE THEORIES

  1. Top of page
  2. Abstract
  3. INTRODUCTION
  4. SCHOLA MEDICA SALERNITANA. WHY DID IT FLOURISH IN SALERNO?
  5. THE LOCATIONS. WHERE WAS IT CENTERED?
  6. THE ORIGINS
  7. THE THEORIES
  8. CONCLUSIONS
  9. Acknowledgements
  10. REFERENCES

The scientific bases of the School of Salerno were those learned from the reading of texts in Latin and Greek, and therefore the humoral theories of Hippocrates and Galen, but also the writings of Constantine the African translated from Arabic [Sudhoff, 1932], and the meeting with the neighboring Jewish medical culture (in Salerno was there a Jewish community in the area between the present church of St. Lucia and St. George).

Contraria Contrariis Curantur

The therapies of the Salernitan School were based on the “doctrine of the four humors” (blood is moist and warm, black bile is dry and cold, yellow bile is hot and dry, and phlegm cold and moist), which corresponded to the four elements (air, earth, fire, and water), that make up life. The humors and the elements were believed to be together in a relationship of balanced antagonism, and the human body was therefore ruled by the presence of these four humors; the disturbance of this balance caused disease. The basic concept was that illness is a disharmony, an excess (or a sin according to Catholic belief), to which the organism must respond to restore the right balance [Pasca, 2005]. Pathology was to be counteracted using a compound (simple hot and humid, hot and dry, cold and wet, and cold and dry) of a nature opposite the humor produced in excess by the body. The “theory of four humors” would dominate unchallenged from 500 B.C. until the revolution of Virchow in 1858.

Among the works handed down, the most representative of the literature is the Regimen Sanitatis or Flos medicinae Salerni, a collection of advice, precepts, and maxims that summarizes the scientific knowledge of the period, with health maxims for a life that was balanced and ordered, resorting to the use of herbs and natural remedies [Capone, 2005]. Even this was a concept of extraordinary relevance to modern times, considering the strong belief today that most preventable diseases are associated with a healthy and sober lifestyle, away from extremes and risks of various kinds, and the increasing use of medical care alternatives.

Among the specialized fields of interest was surgery, for which there remain the texts such as the Practica chirurgiae by Ruggero di Frugardo, who is credited with giving impetus to a new discipline, and that of his pupil Guido D'Arezzo, who formulated the treatise Chirurgia Magisteri Rogerii, the first official text of the XII–XV centuries and the first document of Italian surgery. Other specializations included ophthalmology, urology, and neurology. It is interesting to note that they mentioned maladies such as headache and epilepsy [de Frutos-González and Guerrero-Peral, 2009; Guerrero-Peral and de Frutos-González, 2010]. The style of teaching was much more practical than theoretical, being based upon experiences and knowledge developed over time.

Women

The School of Salerno also boasts names of women of great learning, called “mulieres salernitanae” (salernitan wives) [Bayon, 1940]. They not only practiced in the medical profession [Ferraris and Ferraris, 1997], but also taught in the school and wrote texts. Compared to the role of women in the Middle Ages, they are the pride of medieval Salerno and a symbol of its liberality. At that time, women were associated with the image of Eve who caused the “original sin,” and therefore was a temptress and sinner. In terms of social levels, the highest was as Princess, Lady, the “Madonna,” but still women's roles were supportive and secondary compared to men who were at the center and held the power (the King, the crusader, and the knight). Instead, in the Salernitan medical landscape, names of women stand out such as Trotula De Ruggiero, Abella Salernitana, Mercuriade, Rebecca Guarna, Maria Incarnata, and Constanza Calenda [De Renzi, 1852; Boggi Cavallo, 1994]. Figuring most prominent is Trotula De Ruggiero (1035/40-1097), whose name is tied to such works as “De mulierum passionibus ante, in et post partum,” a real and true treatise on obstetrics and gynecology of the Middle Ages [Boggi Cavallo, 1994; Green, 2001, 2009]. This work was actually a collection of her writings or her lectures. The first printing was edited by George Kraut and published in Stuttgart in 1544, followed in 1547 by the Aldina in Venice. In the latter part of this work (De ornatu) there are precepts and concepts concerning the physical and mental health of a woman and her child. It was not until the late 19th century before another woman was to be awarded a medical degree.

Children

Between 861 and 865, Guaiferio had built, near his princely palace, a “domus pulchra” with high walls, the church of Saint Massimo, which is attached to a hospice, the first ever known in Salerno, “in service of pilgrims and travelers, and cared especially for the poor, children, and widows, in a word, the needy.” Moreover, the texts of “De Mulierum passionibus” referred not only to women but also to their newborn babies. It gave directions in a form that could be called “pediatrics,” albeit, empirical experiences, and notions handed down by the ancient Greek and Latin texts, inevitably related to the limited scientific knowledge of the time. For example, they gave advice for preventing the milk from entering the ears and nose when the baby was fed. Perfectly suited to today's knowledge and sensitivity is the suggestion to create an environment as serene as possible around the baby: “Near him pronounce simple chants and words, never sing with harsh or hoarse voice” (Coram et eo cantilenis facilibus utendum vocibus, nec asperis vocibus cantandum neque raucis, Chapter XVIII). Or there were tips for relieving the discomfort of teething: “When the moment arrives for the teeth to emerge, rub the gums every day with butter and chicken fat, and the gums will soften with barley water” (Cum tempus Nativitatis dentium venerit, gingivae singulis diebus cum butyro et axungia gallinae saepe fricandasunt et aqua ordei linienda, Chapter XVIII) [Montinaro, 2003].

Birth Defects?

Apparently there are no traces or mention of congenital defects. How is it possible that the birth of a baby with birth defects was ignored in the same context in which pregnancy and childbirth were the focus of attention and care, where there was a “feminine” culture for the mother and her child? Various hypotheses can be proposed: the first and most immediate is that the different person was not accepted. “During the medieval period, malformed infants or children were considered a product of the devil or as an indication of divine wrath, thus justifying the killing. Children born with malformations such as phocomelia, syndactyly, ichthyosis, and clubfoot, were thought to be generated by the devil. These children and/or their mothers were usually destined to die shortly after birth, while the small or weak were not cared for. At that time a method for removal of unwanted children or disabled people was drowning” [Muratt, 2011]. However, we believe that this is not the only explanation. Instead it is very probable that, given the conditions of the time, there was a high rate of miscarriage or other prenatal and neonatal mortality. We know today with certainty that only the current development of some specialized branches, such as neonatal intensive care and pediatric surgery, and in particular cardiovascular and neurosurgery, have allowed the survival of many with syndromes that otherwise would have had an ominous prognosis. We can therefore assume that in the Middle Ages many genetic syndromes could have had an exitus very early and thus be “removed” as negative experiences. Moreover, the basic premise of Salernitan medicine was the idea of illness as a sin, and pain as the atonement. Finally, other conditions that were completely non-lethal or severe (or therefore, striking) could have been interpreted and described differently at the time. Let us reread some passages of “De Mulierum passionibus” [Green, 2009] and try to understand if from these descriptions we can imagine something that could not be understood at the time.

Infertility

The contemporary approach to the problems of infertility and sterility in couples provides an accurate diagnostic procedure, which both the man and the woman must undergo. Well, this “modern” concept was also clear to the male and female doctors of the Medical School of Salerno, who argued that infertility may be due to the woman or the man: “Hoc erit aut vicio mulieris sive mariti” (par. 4 De Mulierum passionibus) [Green, 2009].

Amenorrhea

When women did not menstruate, “Aliquando mulieribus deficiunt menstrua,” the treatise identified possible anatomical defects underlying this condition (par. 7 De Mulierum Passionibus) [Green, 2009]. It was held that the cause might be that the woman was too fat or even the opposite: (“Si fuerit gracilis et frigida;” frail and frigid), and it is intriguing to think how some associations, such as edema (“ydropisis”), and “heart pains” (“vel morsus accidunt cordis”), which were described as a consequence of the absence of menstruation, may instead be a simple association in the context of a syndrome not recognizable at the time (such as Turner syndrome).

Male Hypogonadism

Some descriptions may refer to situations of male hypogonadism with reduced sexual drive (“Corporis algor erit, saltem genitalia membra”) or small size of the shaft (“virga virilis curta”): Klinefelter? Mosaicism of sex chromosomes? This is followed immediately by a reference to an anomalous urination (“Vel si non mingat directe”), which calls to mind a condition of hypospadias. In any case, it was concluded that all these were sure signs that conception could be very difficult, “Signa dabit certa quod erit conceptio rara” (par. 45, De Mulierum Passionibus) [Green, 2009].

Asymmetry

A description of the possible different lengths of the legs of a child was a clear reference to a birth defect (par. 125, De Mulierum Passionibus) [Green, 2009]. It specified that if a limb was greater than the other it could be reduced to its proper size if the “affliction” was recent: “Si membrum alicuius pueri sit maius quam aliud, ad bonam consuetudinem ita potest reduci, si passio fuerit recens.” Instead, if it was old, there's no way it could be reduced: “Si vetus, nullo modo.” If a limb was greater than the other and if the condition was “old” brings to mind possible genetic conditions characterized by asymmetry of the lower limbs, such as in the syndromes of Silver–Russell or Beckwith Wiedemann. And, precisely in connection with a syndrome of macrosomia, there are no shortage of descriptions in the text of “fetus magnus, crassus vel hydropicus” (large, fat, or edematous fetus).

The miniature of Avicenna

Interesting in this regard is a careful “reading” of the most famous image of Salerno and of the School: the miniature painting (Fig. 6) contained in the manuscript 2197 of the Code of Avicenna (Canon Maior, XIV–XV century), preserved in University Library of Bologna [Pazzini, 1954].

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Figure 6. Miniature painting from the “Canon Medicinae” of Avicenna, 1103 AD. Robert Guiscard takes leave from Salerno. Copyright Biblioteca Universitaria di Bologna. Reproduction is forbidden unless authorized. [Color figure can be seen in the online version of this article, available at http://wileyonlinelibrary.com/journal/ajmga]

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An anonymous artist depicted Salerno in an idealized setting, enclosed within its walls with massive towers and slender steeples, surrounded by fertile hills (the Lattari mountains), and in the sea, sailboats, row boats, or simple fishing boats. In the foreground stands the figure of a man dressed in a crown and red cape, Roberto, Duke of Normandy. This man, returning from the First Crusade and headed for England to occupy the throne left vacant by the death of his brother William, stopped in Salerno, home of the most famous school of medicine in the world at that time, to consult with the learned scholars about an ulcerated wound on his right arm, caused by a poisoned arrow during the siege of Jerusalem. The verdict was merciless: the wound was incurable unless someone sucked the venom by mouth, sacrificing his own life. The Duke refused, but at night, without his knowledge, his wife Sybil of Conversano, sucked the wound, sacrificing her own life. The miniature depicts him at the city gate, bidding farewell to the doctors—among them also women—asking them for a handbook containing the principles of the School. Hence, the dedication of the Regimen Sanitatis to the Anglican king. Bottom, left, the heroic princess, who retains the distinctive crown of his rank, receiving proper burial. On the other hand, the image of a water mill near a stream, the Fusandola, where tradition held that the school began, there is a donkey with a monkey on its back, led behind by a child, whose head appears completely (and abnormally) turned to the viewer of the painting (Fig. 7).

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Figure 7. Detail of the miniature highlighting the abnormal posture of the head and face that appears more like a monkey than a child. [Color figure can be seen in the online version of this article, available at http://wileyonlinelibrary.com/journal/ajmga]

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The head has the features of a child: there is a slight beard, a dark color (hairy?) And one eye open and one closed (or offended?). Or is it the head of a monkey? What does this mean? We do not think it can be only a “whimsical touch” by the author, or that he “wanted to show life in the fields with the passage of the donkey and his load” [Pasca, 2005].

The Middle Ages is rich with allegories and cryptic messages. We suggest another interpretation: the monkey and the donkey could represent heresy and ignorance and, together with the image of dysmorphic child, are in contrast and then deliberately put “in the corner,” outside of the grandeur of the event recounted in the miniature. Is this a picture of the rejection that existed at that time against the disabled? The hypothesis cannot be ruled out, as well as the allegorical meaning of the animals. Consider the so-called “Porta dei Leoni” of the Cathedral of Salerno, above the doorway in the existing frieze (Fig. 8), there is a bas-relief of another monkey (heresy), according to scholars is assumed to have the same meaning (abjuration from the sacred place).

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Figure 8. The monkey on the “Porta dei Leoni” (Door of the Lions) of the Cathedral of Salerno. [Color figure can be seen in the online version of this article, available at http://wileyonlinelibrary.com/journal/ajmga]

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CONCLUSIONS

  1. Top of page
  2. Abstract
  3. INTRODUCTION
  4. SCHOLA MEDICA SALERNITANA. WHY DID IT FLOURISH IN SALERNO?
  5. THE LOCATIONS. WHERE WAS IT CENTERED?
  6. THE ORIGINS
  7. THE THEORIES
  8. CONCLUSIONS
  9. Acknowledgements
  10. REFERENCES

Men, women, and children were certainly actors and protagonists in this coterie of medieval science (Fig. 9).

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Figure 9. Scene of life of the Middle Ages in the Cathedral of Salerno. [Color figure can be seen in the online version of this article, available at http://wileyonlinelibrary.com/journal/ajmga]

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A detailed reading allowed the gathering, inevitably, of hints, and evidence of possible congenital malformations and genetic syndromes. We believe it is still difficult, at present, to draw absolute conclusions about disability, and diversity that had actually been experienced and interpreted. The interpretation we have given on the miniature in the Code of Avicenna leans towards a system of rejection and exclusion. At the same time, however, we should not neglect the great charitable effort in the ancient monasteries; that the monastic pietas had assisted and comforted many of the weak and those with genetic syndromes. However, it is also likely that other people, bearing non-lethal conditions, and thus not limited in their social activities, had lived their lives like the rest of the population, addressing common challenges of all ages, such as infertility. The limited availability of sources, either in writing or in art, may limit our present knowledge. We are confident that more documents and discoveries will further clarify this medieval “mystery” linked to the oldest medical school in the western world.

Acknowledgements

  1. Top of page
  2. Abstract
  3. INTRODUCTION
  4. SCHOLA MEDICA SALERNITANA. WHY DID IT FLOURISH IN SALERNO?
  5. THE LOCATIONS. WHERE WAS IT CENTERED?
  6. THE ORIGINS
  7. THE THEORIES
  8. CONCLUSIONS
  9. Acknowledgements
  10. REFERENCES

The authors acknowledge the Archbishop and the Archbishop's Curia of Salerno Cathedral, the publisher SISMEL of Bologna, and the great efforts of significant contributions to this study by Prof. Corradino Pellecchia. Without their help this work could not be completed.

The authors wish to thank Alice Vuoso-Mauri, Ph.D., for the translation of this document from its original Italian into English.

REFERENCES

  1. Top of page
  2. Abstract
  3. INTRODUCTION
  4. SCHOLA MEDICA SALERNITANA. WHY DID IT FLOURISH IN SALERNO?
  5. THE LOCATIONS. WHERE WAS IT CENTERED?
  6. THE ORIGINS
  7. THE THEORIES
  8. CONCLUSIONS
  9. Acknowledgements
  10. REFERENCES
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